National Provider Identifier
Jack Richard Bansbach
Jack Richard Bansbach is listed in the NPPES registry with a primary specialty of Dentist in Rochester, NY and a listed phone number of (585) 353-9655.
Profile Overview
- NPI
- 1952002412
- Provider Type
- Individual
- Primary Specialty
- Dentist
- Enumeration Date
- March 13, 2023
- Last Updated
- April 26, 2024
Practice Location
- 625 Elmwood Ave
- Rochester, NY 14620-2913
Phone: (585) 353-9655
Mailing Address
- 468 French RD
- Rochester, NY 14618-4861
Specialties
- Dentist (122300000X)
- Student in an Organized Health Care Education/Training Program (390200000X)
Full Record
- NPI
- 1952002412
- Entity Type
- Individual
- Last Name
- Bansbach
- First Name
- Jack
- Middle Name
- Richard
- Mailing Street Address
- 468 French RD
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14618-4861
- Mailing Country
- US
- Mailing Phone
- (585) 353-9655
- Practice Street Address
- 625 Elmwood Ave
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14620-2913
- Practice Country
- US
- Practice Phone
- (585) 353-9655
- Enumeration Date
- March 13, 2023
- Last Updated
- April 26, 2024
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- April 26, 2024
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Dentist (122300000X), Student in an Organized Health Care Education/Training Program (390200000X)