Portage Pediatric Dentistry PLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2901020339 Issued in MI

Legal business name

PORTAGE PEDIATRIC DENTISTRY PLC

Practice address

6121 S Westnedge Ave
Portage, MI 49002-2882

Phone

(269) 323-8016

Fax

(269) 323-8524

NPI assigned

Dec 9, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Jody L Wrathall, DDS, MS

Title

Owner

Phone

(269) 323-8016

Specialties & licenses 2

Addresses

Other names 1

• Portage Pediatric Dentistry Doing business as

Locations

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449619200000",
    "number": "1366817827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6121 S WESTNEDGE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490022882",
            "telephone_number": "269-323-8016",
            "fax_number": "269-323-8524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6121 S WESTNEDGE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490022882",
            "telephone_number": "269-323-8016",
            "fax_number": "269-323-8524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE PEDIATRIC DENTISTRY PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-09",
        "last_updated": "2015-12-09",
        "status": "A",
        "authorized_official_last_name": "WRATHALL",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-323-8016",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901020339",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901009877",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portage Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Portage Family Vision Care, PC
• Portage Family Vision Care, PC
• Portage Life Coaching and Counseling LLP
• Portage Northern Dental
• Portage Opco, LLC
• Portage Pharmacy, Inc.
• Portage Podiatry PC
• Maria Portal Caballero
• Christine L. Porter, M.A.SPEECH PATHOLOGY
• Marie Porter

• Pediatric Dentistry in Portage, MI
• Providers in Portage, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.