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).
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 |
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 |
Address | Telephone Number | Fax Number |
---|---|---|
6121 S. Westnedge Ave., Portage, MI 49002 | 2693238016 | 2693838524 |
Street Address |
3020 OLD CENTRE RD |
City | PORTAGE |
State | MI |
Zip Code | 49024 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255822961 | Jackie Hwang | Dentist | 3020 Old Centre Rd, Portage, MI 49024-4883 | 2018-05-29 |
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 |
Find all providers in zip 49024 |
Taxonomy Code | 1223P0221X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | Pediatric Dentistry |
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 |
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 |
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 |
Find all providers with the same taxonomy |
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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.