| Dr Timothy D Supan, DMD | |
|
205 E Gridley Rd, Gridley, IL 61744-8733 | |
| (309) 747-2213 | |
| (309) 747-3989 |
| Full Name | Dr Timothy D Supan |
|---|---|
| Gender | Male |
| Speciality | Dentist - General Practice |
| Location | 205 E Gridley Rd, Gridley, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053316463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Illinois) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Timothy D Supan, DMD Po Box 197, Gridley, IL 61744-0197 Ph: (309) 747-2213 | Dr Timothy D Supan, DMD 205 E Gridley Rd, Gridley, IL 61744-8733 Ph: (309) 747-2213 |
Dr. Stephen T. Blue, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 205 E Gridley Rd, Gridley, IL 61744 Phone: 309-747-2213 Fax: 309-747-3989 | |
Dr. Charles L. Proesel Jr., D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 205 E Gridley Rd, Gridley, IL 61744 Phone: 309-747-2213 Fax: 309-747-3989 |