Healthcare Provider Details

I. General information

NPI: 1932319340
Provider Name (Legal Business Name): MARK EUGENE TRAUTMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 N BUFFALO ST
ORCHARD PARK NY
14127-1853
US

IV. Provider business mailing address

65 TILLINGHAST PL
BUFFALO NY
14216-3408
US

V. Phone/Fax

Practice location:
  • Phone: 716-667-3426
  • Fax:
Mailing address:
  • Phone: 716-835-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number042689
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: