Individual
DR. TIM MICAH SUPIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1412 NE 88TH ST, VANCOUVER, WA 98665-9620
(360) 574-4074
Mailing address
1412 NE 88TH ST, VANCOUVER, WA 98665-9620
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE00010813
WA
Other
Enumeration date
06/08/2007
Last updated
07/31/2013
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