Healthcare Provider Details

I. General information

NPI: 1346168838
Provider Name (Legal Business Name): ISABELLA BRIANNA GONSALVES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W WATKINS ST
PHOENIX AZ
85003-2830
US

IV. Provider business mailing address

2062 E CAMERON WAY APT 3028
TEMPE AZ
85288-7074
US

V. Phone/Fax

Practice location:
  • Phone: 602-850-6900
  • Fax:
Mailing address:
  • Phone: 514-834-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: