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Individual

DR. JODY LYNN WRATHALL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.D.S., M.S.

Contact information

Practice address
3020 OLD CENTRE RD, PORTAGE, MI 49024
(269) 328-8016
(269) 323-8524
Mailing address
3020 OLD CENTRE RD., PORTAGE, MI 49024
(269) 323-8016
(269) 323-8524

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
2901020339
MI
1223P0221X
Pediatric Dentistry
Primary
2901020339
MI

Other

Enumeration date
01/31/2011
Last updated
03/17/2018
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