Provider Demographics
NPI:1902237381
Name:SMART MOUTH PLLC
Entity Type:Organization
Organization Name:SMART MOUTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:RIDER
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-399-9000
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16801261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134118870OtherINDIVIDUAL PROVIDER NPI