Healthcare Provider Details

I. General information

NPI: 1457053365
Provider Name (Legal Business Name): TAYLOR AMANDA ROTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 N NOLAN RIVER RD
CLEBURNE TX
76033-7001
US

IV. Provider business mailing address

841 N NOLAN RIVER RD
CLEBURNE TX
76033-7001
US

V. Phone/Fax

Practice location:
  • Phone: 817-382-3029
  • Fax:
Mailing address:
  • Phone: 817-382-3029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number42115
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: