Provider Demographics
NPI:1053439919
Name:PENNINGTON, ROBIN LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:LYNN
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 HWY 80 W.
Mailing Address - Street 2:P.O. BOX 194
Mailing Address - City:COMBS
Mailing Address - State:KY
Mailing Address - Zip Code:41729-0194
Mailing Address - Country:US
Mailing Address - Phone:606-439-3740
Mailing Address - Fax:606-436-2261
Practice Address - Street 1:562 HWY 80 W.
Practice Address - Street 2:
Practice Address - City:COMBS
Practice Address - State:KY
Practice Address - Zip Code:41729-0194
Practice Address - Country:US
Practice Address - Phone:606-439-3740
Practice Address - Fax:606-436-2261
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60048543Medicaid