DR. JODY LYNN WRATHALL D.D.S. M.S. NPI 1306142815

NPI Information

  • NPI: 1306142815
  • Provider Name: DR. JODY LYNN WRATHALL, D.D.S., M.S.
  • Classification: Dentist - 1223P0221X
  • Specialization: Pediatric Dentistry
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 3020 OLD CENTRE RD
    PORTAGE, MI
    ZIP 49024
  • Phone: (269) 328-8016

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NPI Details

DR. Jody Lynn Wrathall, D.D.S., M.S. is a pediatric dentistry dentist in Portage, MI. The provider is 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. DR. Jody Lynn Wrathall, D.D.S., M.S. NPI is 1306142815. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3020 OLD CENTRE RD
PORTAGE, MI
ZIP 49024
Phone: (269) 328-8016
Fax: (269) 323-8524

The NPI 1306142815 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 1/31/2011 and was last updated on 3/17/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1122300000XDentist2901020339MICHIGANNo
21223P0221XDentistPediatric Dentistry2901020339MICHIGANYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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