Provider Demographics
NPI:1740366293
Name:GABRIEL, DOUGLAS R (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:GABRIEL
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 1:21681 N 77TH AVE
Mailing Address - Street 2:STE. 1420
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2132
Mailing Address - Country:US
Mailing Address - Phone:623-376-7233
Mailing Address - Fax:623-376-7234
Practice Address - Street 1:21681 N 77TH AVE
Practice Address - Street 2:STE. 1420
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2132
Practice Address - Country:US
Practice Address - Phone:623-376-7233
Practice Address - Fax:623-376-7234
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice