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PORTAGE PEDIATRIC DENTISTRY
NPI 1366817827
Dentist - Pediatric Dentistry in Portage, MI

Active since December 09, 2015
6121 S WESTNEDGE AVE, PORTAGE, MI 49002(269) 323-8016(269) 323-8524 Get Directions Write a Review

NPPES record last updated: December 9, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Portage Pediatric Dentistry NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PORTAGE PEDIATRIC DENTISTRY (NPI 1366817827) is a healthcare organization registered as a pediatric dentistry in Portage, Michigan and active in the NPI registry since December 2015. The organization lists Jody L Wrathall, Owner, as its authorized official.

NPPES Registry Identity

NPI1366817827
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NamePORTAGE PEDIATRIC DENTISTRY PLC
Location Address6121 S WESTNEDGE AVEPortage, MI 49002-2882
Mailing Address6121 S Westnedge AvePortage, MI 49002-2882 · (269) 323-8016 · Fax (269) 323-8524
Phone(269) 323-8016
Fax(269) 323-8524
Organization SubpartNo
Authorized OfficialJody L WrathallOwner · (269) 323-8016
Enumeration DateDecember 9, 2015
✔ NPI 1366817827 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
Licenses✔ Licensed in MI · 2901020339✔ Licensed in MI · 2901009877
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.
6121 S WESTNEDGE AVE, Portage, MI 49002
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Other Names 1

Doing Business AsPortage Pediatric Dentistry

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JOHN H DEPPEN DDS
Dentist (Pediatric Dentistry)
6121 S WESTNEDGE AVE
PORTAGE, MI 49002
Kalamazoo County (269) 323-8016
KWONG ORTHODONTICS, PC
Dentist (Orthodontics and Dentofacial Orthopedics)
6121 S WESTNEDGE AVE
PORTAGE, MI 49002
Kalamazoo County (269) 366-0882

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Portage Pediatric Dentistry Plc's NPI number?

The NPI number for Portage Pediatric Dentistry Plc is 1366817827. It was assigned to this organization in the NPPES registry on December 9, 2015. The provider is doing business as Portage Pediatric Dentistry.

Where is Portage Pediatric Dentistry Plc located?

Portage Pediatric Dentistry Plc is located at 6121 S Westnedge Ave, Portage, MI 49002. The listed phone number is (269) 323-8016.

What is Portage Pediatric Dentistry Plc's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Portage Pediatric Dentistry Plc was last updated on December 9, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.