DR. Timothy D. Supan, D.M.D. is a general practice dentist in Gridley, IL. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Timothy D. Supan, D.M.D. NPI is 1053316463. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
205 E GRIDLEY RD
GRIDLEY, IL
ZIP 61744-733
Phone: (309) 747-2213
Fax: (309) 747-3989
The NPI 1053316463 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).
The enumeration date for this NPI number is 6/14/2005 and was last updated on 7/8/2007.