Healthcare Provider Details

I. General information

NPI: 1013236819
Provider Name (Legal Business Name): DANE JEFFERY GENTHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE A71
CLEVELAND OH
44195
US

IV. Provider business mailing address

9500 EUCLID AVE A71
CLEVELAND OH
44195
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-3729
  • Fax: 216-445-9409
Mailing address:
  • Phone: 216-445-3729
  • Fax: 216-445-9409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number35.133967
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: