Healthcare Provider Details

I. General information

NPI: 1134118870
Provider Name (Legal Business Name): AMANDA RIDER TROTTER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 OLD HEWITT RD
WACO TX
76712-6560
US

IV. Provider business mailing address

3119 RIVER PLACE DR
BELTON TX
76513-1013
US

V. Phone/Fax

Practice location:
  • Phone: 254-399-9000
  • Fax: 254-399-9001
Mailing address:
  • Phone: 254-933-9826
  • Fax: 254-399-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number16801
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: