Healthcare Provider Details

I. General information

NPI: 1902237381
Provider Name (Legal Business Name): SMART MOUTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number16801
License Number StateTX

VIII. Authorized Official

Name: DR. AMANDA RIDER TROTTER
Title or Position: OWNER/PEDIATRIC DENTIST
Credential: DDS
Phone: 254-399-9000