Provider Demographics
NPI:1295258085
Name:PENNINO, CONNOR ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:ANDREW
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 1:203 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3104
Mailing Address - Country:US
Mailing Address - Phone:847-381-6222
Mailing Address - Fax:
Practice Address - Street 1:203 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3104
Practice Address - Country:US
Practice Address - Phone:847-381-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0312801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice