Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. TIMOTHY D. SUPAN, D.M.D.
ActiveDR. TIMOTHY D. SUPAN, D.M.D. is a General Dentistry healthcare provider located in GRIDLEY, Illinois. NPI 1053316463 is currently active in the NPPES registry. Verify at CMS.
General Dentistry · GRIDLEY, IL
Registration Details
- NPI Number
- 1053316463
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 14, 2005 (21.183251573058 yrs)
- Last Updated
- Jul 8, 2007
Practice Information
- Address
-
205 E GRIDLEY RDGRIDLEY, IL, 617448733Browse IL providers · Browse ZIP 61744
- Phone
- 3097472213
- Fax
- 3097473989
- Primary Specialty
-
General Dentistry
1223G0001X
Other General Dentistry Providers in GRIDLEY, IL
| Name | Credential | NPI |
|---|---|---|
| DR. STEPHEN T. BLUE | D.D.S. | 1205831773 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.