Individual
DR. JOEL A SUPITA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
519 N US HIGHWAY 141, CRIVITZ, WI 54114-1639
(715) 854-7545
Mailing address
W7592 E 26TH RD, CRIVITZ, WI 54114-7366
(715) 854-7409
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2824-015
WI
Other
Enumeration date
05/19/2006
Last updated
07/08/2007
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