Organization
TUCSON SMILES PEDIATRIC DENTISTRY AT LA CHOLLA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAILA BAHARLOO HISHAW D.D.S. (PEDIATRIC DENTIST)
(520) 544-4171
Entity
Organization
Contact information
Practice address
5920 N LA CHOLLA BLVD STE 110, TUCSON, AZ 85741-3693
(520) 544-4171
(520) 544-4172
Mailing address
5920 N LA CHOLLA BLVD STE 110, TUCSON, AZ 85741-3693
(520) 544-4171
(520) 544-4172
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D5679
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
791021
—
AZ
Enumeration date
05/10/2007
Last updated
05/02/2014
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