Susan J Sup, DDS
Individual provider Active NPI Dentist · Grantsburg, WI
NPI 1093857799 · NPPES record last updated Oct 1, 2025
Key facts
- NPI
- 1093857799
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6001364-15 (WI)
- Practice address
- 302 S Pine St
Grantsburg, WI 54840-7930 - Phone
- (315) 657-2719
- NPI assigned
- Feb 12, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Dentist
- Education
- Other, 1980
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1300 National Dr
Suite 135
Sacramento, CA 95834-1947
PO Box
Suite 769
Redway, CA 95560
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1917286 | IL | MD | Dentist |
| 6001364-15 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark a. Ligocki, DDS, PC. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1917286 | IL | |
| Dentist | 122300000X | 6001364-15 | WI | Yes |
Addresses
Primary practice location
302 S Pine St
Grantsburg, WI 54840-7930
Mailing address
302 S Pine St Ste 203
Grantsburg, WI 54840-7930
Other practice location 1
200 East Willow
Suite 203
Wheaton, IL 60187-5445
Phone (630) 665-7400
Other providers in Grantsburg, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.