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Active NPI 1053316463 Individual Practitioner Male Practitioner

Dr. Timothy D. Supan , DMD

Dentist - General Practice • Gridley, IL

Professional Overview & Biography Verified Profile Summary

Dr. Timothy Supan, DMD is a registered healthcare professional specializing in Dentist - General Practice in Gridley, IL. Practice services are available at 205 E GRIDLEY RD under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

205 E Gridley Rd

Gridley, IL 617448733

Telephone 3097472213
Fax 3097473989

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Gridley, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
2 Specialists

Practicing in Gridley, IL (5581 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
Dr. Stephen Blue , DDS

Dentist - General Practice

NPI 1205831773

Doctor of Dental Surgery

Dr. Charles Proesel , DDS

Dentist - Dental Public Health

NPI 1972508364

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 205 E GRIDLEY RD, GRIDLEY, IL 617448733 (Tel: 3097472213)

📍
Updated Business Mailing Address July 08, 2007

Registered at PO BOX 197, GRIDLEY, IL 617440197 (Tel: 3097472213)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as TIMOTHY SUPAN, D.M.D.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist

🟢
Initial NPI Registration & Enumeration June 14, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1053316463
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 14, 2005
Last Update: July 13, 2026
Sole Proprietor: No

Mailing Address

Po Box 197

Gridley, IL 617440197

Phone: 3097472213

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.