Healthcare Provider Details

I. General information

NPI: 1093916629
Provider Name (Legal Business Name): ROGER W TRIFTSHAUSER DDS AND MARLIN S SALMON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5A BATAVIA CITY CENTRE
BATAVIA NY
14020-2168
US

IV. Provider business mailing address

5A BATAVIA CITY CENTRE
BATAVIA NY
14020-2168
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-0775
  • Fax: 585-344-2441
Mailing address:
  • Phone: 585-344-0775
  • Fax: 585-344-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0233941
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0358471
License Number StateNY

VIII. Authorized Official

Name: DR. MARLIN S SALMON
Title or Position: V PRES SEC
Credential: DDS
Phone: 585-344-0775