Provider Demographics
NPI:1093916629
Name:ROGER W TRIFTSHAUSER DDS AND MARLIN S SALMON DDS PC
Entity Type:Organization
Organization Name:ROGER W TRIFTSHAUSER DDS AND MARLIN S SALMON DDS PC
Other - Org Name:BROWN DEENEY TRIFTSHAUSER DDS PC
Other - Org Type:Other Name
Authorized Official - Title/Position:V PRES SEC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-344-0775
Mailing Address - Street 1:5A BATAVIA CITY CENTRE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2168
Mailing Address - Country:US
Mailing Address - Phone:585-344-0775
Mailing Address - Fax:585-344-2441
Practice Address - Street 1:5A BATAVIA CITY CENTRE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2168
Practice Address - Country:US
Practice Address - Phone:585-344-0775
Practice Address - Fax:585-344-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02339411223X0400X
NY03584711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00627656Medicaid
NM00982292Medicaid