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General NPI Number Information
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NPI Number | 1285551440
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Entity Type | Individual
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Provider Name | ISABELLA GAXIOLA
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Gender | Female
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 420 E SOUTH TEMPLE
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-1319
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Country | US
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Telephone | 385-452-6705
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Fax |
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Provider Business Mailing Address
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Address Line | 340 E 200 S APT 542
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-3257
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Country | US
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Telephone | 714-853-5522
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 142854679926
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License Number State | UT
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