Individual
JACK RICHARD BANSBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
625 ELMWOOD AVE, ROCHESTER, NY 14620-2913
(585) 353-9655
Mailing address
468 FRENCH RD, ROCHESTER, NY 14618-4861
(585) 353-9655
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN28832
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/13/2023
Last updated
04/26/2024
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