Provider Demographics
NPI:1194478834
Name:DODENHOFF, GABRIEL BENJAMIN
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:BENJAMIN
Last Name:DODENHOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 REBECCA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764-1704
Mailing Address - Country:US
Mailing Address - Phone:774-218-8158
Mailing Address - Fax:
Practice Address - Street 1:1295 REBECCA RD
Practice Address - Street 2:
Practice Address - City:NORTH DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02764-1704
Practice Address - Country:US
Practice Address - Phone:774-218-8158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACHW00516172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker