Provider Demographics
NPI:1932319340
Name:TRAUTMAN, MARK EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EUGENE
Last Name:TRAUTMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 TILLINGHAST PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3408
Mailing Address - Country:US
Mailing Address - Phone:716-835-5502
Mailing Address - Fax:
Practice Address - Street 1:3725 N BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1853
Practice Address - Country:US
Practice Address - Phone:716-667-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0426891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry