Provider Demographics
NPI:1134118870
Name:TROTTER, AMANDA RIDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:RIDER
Last Name:TROTTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 RIVER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-1013
Mailing Address - Country:US
Mailing Address - Phone:254-933-9826
Mailing Address - Fax:254-399-9002
Practice Address - Street 1:211 OLD HEWITT RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6560
Practice Address - Country:US
Practice Address - Phone:254-399-9000
Practice Address - Fax:254-399-9001
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry