Provider Demographics
NPI:1700895216
Name:HISHAW, LAILA BAHARLOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAILA
Middle Name:BAHARLOO
Last Name:HISHAW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LAILA
Other - Middle Name:BADRI
Other - Last Name:BAHARLOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5920 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3590
Mailing Address - Country:US
Mailing Address - Phone:520-544-4171
Mailing Address - Fax:520-544-4172
Practice Address - Street 1:5920 N LA CHOLLA BLVD
Practice Address - Street 2:STE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3590
Practice Address - Country:US
Practice Address - Phone:520-544-4171
Practice Address - Fax:520-544-4172
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry