Healthcare Provider Details

I. General information

NPI: 1285551440
Provider Name (Legal Business Name): ISABELLA GAXIOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E SOUTH TEMPLE
SALT LAKE CITY UT
84111-1319
US

IV. Provider business mailing address

340 E 200 S APT 542
SALT LAKE CITY UT
84111-3257
US

V. Phone/Fax

Practice location:
  • Phone: 385-452-6705
  • Fax:
Mailing address:
  • Phone: 714-853-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number142854679926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: