Provider Demographics
NPI:1255403655
Name:DANNER, JEFFREY LEO (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEO
Last Name:DANNER
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 1:4385 EVERHARD RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2403
Mailing Address - Country:US
Mailing Address - Phone:330-494-6016
Mailing Address - Fax:330-494-5339
Practice Address - Street 1:4385 EVERHARD RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2403
Practice Address - Country:US
Practice Address - Phone:330-494-6016
Practice Address - Fax:330-494-5339
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice