| 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. Nicole Eileen Elger, D.M.D. Dentist Medicare: Not Enrolled in Medicare Practice Location: 205 E Gridley Rd, Gridley, IL 61744 Phone: 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  |