Timothy D. Supan D.M.D.

NPI 1053316463 - Dentist - 1223G0001X

NPI Details
NPI 1053316463
Gender Male
Enumeration Date 06/14/2005
Last Updated 07/08/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
205 E GRIDLEY RD
GRIDLEY IL, 61744-8733, US
Phone (309) 747-2213
Fax (309) 747-3989
Business Location
PO BOX 197
GRIDLEY IL, 61744-0197, US
Phone (309) 747-2213
Fax (309) 747-3989
Toxanomy
Taxonomy Code 1223G0001X
License State
License Number
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According to our database, Dr. Timothy D. Supan D.M.D. NPI is 1053316463, taxonomy code is 1223G0001X Timothy D. Supan D.M.D. physically located at 205 E Gridley Rd, Gridley IL, 61744-8733. NPI Number Timothy D. Supan D.M.D. has the Individual type.

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1053316463 NPI number is provided on an as is basis without warranty of any kind. 1053316463 is maintained by the National Plan & Provider Enumeration System. The contents of Timothy D. Supan D.M.D. are for informational purposes only.