Organization
PORTAGE PEDIATRIC DENTISTRY PLC
Active
Other names
Portage Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JODY L WRATHALL DDS, MS (OWNER)
(269) 323-8016
Entity
Organization
Contact information
Practice address
6121 S WESTNEDGE AVE, PORTAGE, MI 49002-2882
(269) 323-8016
(269) 323-8524
Mailing address
6121 S WESTNEDGE AVE, PORTAGE, MI 49002-2882
(269) 323-8016
(269) 323-8524
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
2901009877
MI
1223P0221X
Pediatric Dentistry
Primary
2901020339
MI
Other
Enumeration date
12/09/2015
Last updated
12/09/2015
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