Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack Richard Bansbach

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1952002412

Jack Richard Bansbach is a Student in an Organized Health Care Education/Training Program in Rochester, New York. Licensed in Florida. Registered with an NPI since 2023.

Licensed in
FL
In the registry since
2023
Specialties on file
2

Practice location Address checks out

625 Elmwood Ave
Rochester, NY 14620-2913
Phone: (585) 353-9655
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence DN28832 (FL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1952002412
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 13, 2023
Last updated in NPPESApril 26, 2024
Certification dateApril 26, 2024
Mailing address468 French Rd, Rochester, NY 14618-4861

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