Provider Demographics
NPI:1831125160
Name:SUPANCIC, JAMES STEVEN JR (DDS,MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVEN
Last Name:SUPANCIC
Suffix:JR
Gender:M
Credentials:DDS,MD
Other - Prefix:
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Mailing Address - Street 1:2748 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4332
Mailing Address - Country:US
Mailing Address - Phone:559-625-9770
Mailing Address - Fax:559-625-9774
Practice Address - Street 1:2748 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4332
Practice Address - Country:US
Practice Address - Phone:559-625-9770
Practice Address - Fax:559-625-9774
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA367001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF92070Medicare UPIN