DR. JODY LYNN WRATHALL


Address: 3020 Old Centre Rd, Portage, MI 49024
Phone: 2693288016

DR. JODY LYNN WRATHALL (NPI# 1306142815) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1306142815
Entity Type Individual
Full Name DR. JODY LYNN WRATHALL
Other Name MS. JODY LYNN CHAPMAN
Credential D.D.S., M.S.
Practice Address 3020 Old Centre Rd
Portage
MI 49024
Mailing Address 3020 Old Centre Rd.
Portage
MI 49024
Practice Telephone 2693288016
Practice Fax Number 2693238524
Mailing Telephone 2693238016
Mailing Fax Number 2693238524
Enumeration Date 2011-01-31
Last Update Date 2018-03-17
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 122300000X Dentist 2901020339 MI Dental Providers
Y 1223P0221X Dentist
Specialization: Pediatric Dentistry
2901020339 MI Dental Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
6121 S. Westnedge Ave., Portage, MI 49002 2693238016 2693838524

Office Location

Street Address 3020 OLD CENTRE RD
City PORTAGE
State MI
Zip Code 49024

Providers in the same location

NPI Name Taxonomy Address Enumeration
1255822961 Jackie Hwang Dentist 3020 Old Centre Rd, Portage, MI 49024-4883 2018-05-29

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1134774524 Antonio Richard Barron Physician Assistant 5717 Oakland Dr Ste A, Portage, MI 49024 2019-08-03
1699279240 Julie Lynn Griffin Specialist/Technologist Portage Northern High School, 1000 Idaho Ave, Portage, MI 49024 2018-03-20
1194255711 Brittany Lynn Finkler Audiologist 576 Romence Rd Ste 121, Portage, MI 49024 2017-06-15
1164881207 Family & Children Services, Inc. Clinic/Center 1302 W Milham Ave, Portage, MI 49024 2016-02-17
1497127716 Huber Counseling, LLC Counselor 1591 West Centre Ave, Suite 102, Portage, MI 49024 2015-10-26
1659757466 Marie Porter Rehabilitation Practitioner 5724 Alten St, Portage, MI 49024 2015-08-04
1063824860 George Hughes General Practice 6630 Sunburst Dr, Portage, MI 49024 2014-05-28
1922358407 Kimberly Lynn Ellrich Speech-Language Pathologist Storypoint, 3951 W Milham Ave, Portage, MI 49024 2012-09-12
1942593744 Shamika Hall, Ph.d. & Associates, Pllc Community/Behavioral Health 7901 S. 12th St., Suite 201, Portage, MI 49024 2011-05-26
1124356092 Novel Responses, Inc. Community/Behavioral Health 526 West Centre Ave., Portage, MI 49024 2009-12-03
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Taxonomy Information

Taxonomy Code 1223P0221X
Grouping Dental Providers
Classification Dentist
Specialization Pediatric Dentistry

Taxonomy Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Notes: Source: Council on Dental Education and Licensure, American Dental Association

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1134117807 John H Deppen Dentist 6121 S Westnedge Ave, Portage, MI 49002-2882 2005-10-07
1205453149 Chuandi Wang Pediatric Dentistry PC Dentist 5907 Oakland Dr, Portage, MI 49024-1120 2020-06-26
1255822961 Jackie Hwang Dentist 3020 Old Centre Rd, Portage, MI 49024-4883 2018-05-29
1366817827 Portage Pediatric Dentistry Plc Dentist 6121 S Westnedge Ave, Portage, MI 49002-2882 2015-12-09

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1033717558 Discover Smiles Pediatric Dentistry Dentist 2277 Science Pkwy Ste 2, Okemos, MI 48864-2551 2020-10-16
1740898873 Megan E Stowers Dds Ms Plc Dentist 7459 Middlebelt Rd Ste 1, West Bloomfield, MI 48322-4184 2020-07-15
1447884069 Jocelyn M. Robelli Dds, Ms, Pllc Dentist 18245 E 10 Mile Rd Ste 110, Roseville, MI 48066-5807 2020-02-24
1457914038 Mitten Kids Dentistry Caledonia Plc Dentist 6477 Cherry Meadow Dr Se Ste 4, Caledonia, MI 49316-7351 2019-04-18
1780143982 Childrens Dental Specialists of Hazel Park Pllc Dentist 22241 John R Rd, Hazel Park, MI 48030-1716 2019-03-18
1487128120 Dental Group Associates PC Dentist 4505 Cascade Rd Se # B, Grand Rapids, MI 49546-8381 2019-01-16
1184194433 Pediatric Dental Specialists of West Michigan Dentist 2155 E Paris Ave Se Ste 120, Grand Rapids, MI 49546-6142 2018-11-29
1811465990 Kingma Pediatric Dentistry Pllc Dentist 1179 E Paris Ave Se Ste 130, Grand Rapids, MI 49546-3682 2018-11-07
1407322548 Great Lakes Bay Pediatric Dentistry, Plc Dentist 5605 Colony Dr N Ste 2, Saginaw, MI 48638-7187 2018-10-16
1063987725 Little Red Pediatric Dentistry, Plc Dentist 12723 N Bellwood Dr Ste 20, Holland, MI 49424-7275 2018-10-09
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Competitor

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City PORTAGE
Zip Code 49024

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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