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 12 years ago
Practice Location
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
Taxonomy Code 1223G0001X
License State
License Number
Remove 1053316463 NPI Number

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.