Individual
SUSAN J SUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
302 S PINE ST, GRANTSBURG, WI 54840-7930
(315) 657-2719
Mailing address
302 S PINE ST STE 203, GRANTSBURG, WI 54840-7930
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1917286
IL
122300000X
Dentist
Primary
6001364-15
WI
Other
Enumeration date
02/12/2007
Last updated
10/01/2025
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