Healthcare Provider Details

I. General information

NPI: 1861640773
Provider Name (Legal Business Name): ROGER W TRIFTSHAUSER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5A BATAVIA CITY CTR.
BATAVIA NY
14020-2107
US

IV. Provider business mailing address

5A BATAVIA CITY CTR
BATAVIA NY
14020-2107
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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: