Individual
JAMES R SUEPPEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
238 FRONT STREET, SCENIC BLUFFS HEALTH CENTER, CASHTON, WI 54619
(608) 654-5100
(608) 654-5120
Mailing address
P.O. BOX 39, 238 FRONT STREET SCENIC BLUFFS HEALTH CENTER, CASHTON, WI 54619
(608) 654-5100
(608) 654-5120
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
07543
IA
1223G0001X
General Practice Dentistry
Primary
6171-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080200
—
IA
01
—
07543
IA STATE LICENSE #
IA
05
—
1003913
—
IL
01
—
1417959
CONTROLLED SUBSTANCE#
IA
05
—
1558357020
—
WI
01
—
421060724
BILLING TAX ID# FOR CHC
IA
01
—
7543
DELTA DENTAL (IA)
IA
01
—
990360
UNITED CONCORDIA
—
01
—
IA0156
JOHN DEERE EDI#
IA
Enumeration date
09/21/2005
Last updated
03/07/2023
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