Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Portage Pediatric Dentistry PLC

Organization Pediatric Dentistry · NPI 1366817827

Portage Pediatric Dentistry PLC is a Pediatric Dentistry in Portage, Michigan. Licensed in Michigan. Registered with an NPI since 2015.

Licensed in
MI
In the registry since
2015
Specialties on file
2

Practice location Address checks out

6121 S Westnedge Ave
Portage, MI 49002-2882
Phone: (269) 323-8016
Fax: (269) 323-8524
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Dentistry (primary) Taxonomy 1223P0221X · Licence 2901020339 (MI)
Pediatric Dentistry Taxonomy 1223P0221X · Licence 2901009877 (MI)

Record details

NPI number1366817827
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jody Wrathall — Owner · (269) 323-8016
Other names Portage Pediatric Dentistry
NPI enumeratedDecember 9, 2015
Last updated in NPPESDecember 9, 2015
Mailing address6121 S Westnedge Ave, Portage, MI 49002-2882

Other providers in Portage