MEDICARE: ROGER W TRIFTSHAUSER DDS AND MARLIN S SALMON DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0358471	NY
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0233941	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

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

Provider Business Mailing Address
First Line	:	5A BATAVIA CITY CENTRE
Second Line	:
City	:	BATAVIA
State	:	NY
Zip	:	14020-2168
Country	:	US
Telephone Number	:	585-344-0775
Fax Number	:	585-344-2441

Provider Business Practice Location Address
First Line	:	5A BATAVIA CITY CENTRE
Second Line	:
City	:	BATAVIA
State	:	NY
Zip	:	14020-2168
Country	:	US
Telephone Number	:	585-344-0775
Fax Number	:	585-344-2441

Authorized Official
Title or Position	:	V PRES SEC
Name	:	DR. MARLIN S SALMON
Credential	:	DDS
Telephone Number	:	585-344-0775

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/22/2020

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