Susan J Sup, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

6001364-15 Issued in WI

Practice address

302 S Pine St
Grantsburg, WI 54840-7930

Phone

(315) 657-2719

NPI assigned

Feb 12, 2007

Last updated

Sep 25, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Specialty

Dentist

Education

Other, 1980

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mark a. Ligocki, DDS, PC.

  dba Ligocki Dental Group

  • Dental Clinic/Center
  • Oakbrook Terrace, IL
  • NPI 1457770893
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790294400000",
    "number": "1093857799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 S PINE ST STE 203",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 S PINE ST",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407930",
            "telephone_number": "315-657-2719"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3750 Rohnerville Rd",
            "address_purpose": "LOCATION",
            "city": "Fortuna",
            "state": "CA",
            "postal_code": "955403118",
            "country_code": "US",
            "telephone_number": "707-725-2978",
            "fax_number": "707-725-2978",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 East Willow",
            "address_2": "Suite 203",
            "address_purpose": "LOCATION",
            "city": "Wheaton",
            "state": "IL",
            "postal_code": "601875445",
            "country_code": "US",
            "telephone_number": "630-665-7400",
            "fax_number": "630-665-3646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUP",
        "first_name": "SUSAN",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2026-09-25",
        "certification_date": "2026-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6001364-15",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "1917286",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "112486",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jennifer Stolt, FNP-C
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• Mark L Thayer, MD
• Urology Associates, LTD.
• Abelardo Valdes, DDS
• Blaise Paul Vitale, M.D.

• Dentist in Grantsburg, WI
• Providers in Grantsburg, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.