Susan J Sup, DDS is a medicare enrolled "Dentist" provider in Grantsburg, Wisconsin. She graduated from medical school in 1980 and has 46 years of diverse experience with area of expertise as Dentist. Her current practice location is
302 S Pine St, Grantsburg, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(315) 657-2719.
Susan J Sup is licensed to practice in Wisconsin (license number 6001364-15) and she also participates in the medicare program. She
may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1093857799.
Healthcare Provider's Profile
| Full Name | Susan J Sup |
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| Gender | Female |
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| Speciality | Dentist |
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| Experience | 46 Years |
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| Location | 302 S Pine St, Grantsburg, Wisconsin |
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| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Susan J Sup graduated from medical school in 1980
NPI Data:
- NPI Number: 1093857799
- Provider Enumeration Date: 02/12/2007
- Last Update Date: 10/01/2025
Medicare PECOS Information:
- PECOS PAC ID: 4587149091
- Enrollment ID: I20260402001346
Medical Identifiers
Medical identifiers for Susan J Sup such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1093857799 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 122300000X | Dentist | 1917286 (Illinois) | Secondary |
| 122300000X | Dentist | 6001364-15 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Susan J Sup is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Susan J Sup, DDS
302 S Pine St Ste 203,
Grantsburg, WI 54840-7930
Ph: () - | Susan J Sup, DDS
302 S Pine St,
Grantsburg, WI 54840-7930
Ph: (315) 657-2719 |
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