Provider Demographics
NPI:1326490855
Name:PENNINO, CHASE DOUGLAS (DDS)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:DOUGLAS
Last Name:PENNINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LIONS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3147
Mailing Address - Country:US
Mailing Address - Phone:224-655-6384
Mailing Address - Fax:
Practice Address - Street 1:101 LIONS DR STE 100
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3147
Practice Address - Country:US
Practice Address - Phone:224-655-6384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0308271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice