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SUSAN J SUP DDS
NPI 1093857799
Dentist in Grantsburg, WI

Active since February 12, 2007PECOS Enrolled
302 S PINE ST, GRANTSBURG, WI 54840(315) 657-2719 Get Directions Write a Review

NPPES record last updated: October 1, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Susan J Sup Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUSAN J SUP DDS (NPI 1093857799) is an individual dentist in Grantsburg, Wisconsin, licensed in Wisconsin (6001364-15) and active in the NPI registry since February 2007. She is enrolled in Medicare PECOS, maintains a secondary practice location in Wheaton, and is a graduate of Other (1980).

NPPES Registry Identity

NPI1093857799
Entity TypeIndividualFemale
Primary Taxonomy122300000X
Provider Legal NameSUSAN J SUPCredential: DDS
Location Address302 S PINE STGrantsburg, WI 54840-7930
Mailing Address302 S Pine St Ste 203Grantsburg, WI 54840-7930
Phone(315) 657-2719
Sole ProprietorNo
Medical School CMSOtherGraduated 1980
Enumeration DateFebruary 12, 2007
Last NPPES UpdateOctober 1, 2025
NPPES CertifiedOctober 1, 2025
✔ NPI 1093857799 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
Licenses✔ Licensed in WI · 6001364-15✔ Licensed in IL · 1917286
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
302 S PINE ST, Grantsburg, WI 54840
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Secondary Practice Location 1

Location 1200 East Willow, Suite 203Wheaton, IL 60187-5445 · Phone (630) 665-7400 · Fax (630) 665-3646

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Susan J Sup Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4587149091
PECOS Enrollment IDI20260402001346
Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54840 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
Established Patient
$67.37 typical visit price
range $17.40 – $133.76
Typical copayment $16.84 (range $4.35 – $33.44)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ABELARDO VALDES DDS
Dentist
302 S PINE ST
GRANTSBURG, WI 54840
Burnett County (630) 819-4181

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Susan Sup's NPI number?

The NPI number for Susan Sup is 1093857799. It was assigned to this individual provider in the NPPES registry on February 12, 2007.

Where is Susan Sup located?

Susan Sup practices at 302 S Pine St, Grantsburg, WI 54840. The listed phone number is (315) 657-2719.

What is Susan Sup's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Susan Sup enrolled in Medicare?

Yes. Susan Sup is registered in the Medicare PECOS enrollment system.

What insurance does Susan Sup accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas, Humana and Renaissance Dental list Susan Sup as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Susan Sup was last updated on October 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.