Provider Demographics
NPI:1407052301
Name:BANSCH, JASON PHILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:PHILIP
Last Name:BANSCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1627
Mailing Address - Country:US
Mailing Address - Phone:610-547-5818
Mailing Address - Fax:
Practice Address - Street 1:1021 PONTIAC RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4816
Practice Address - Country:US
Practice Address - Phone:610-449-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0372431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice