Provider Demographics
NPI:1114766565
Name:JUSTIN HARLOW DDS PA 3
Entity type:Organization
Organization Name:JUSTIN HARLOW DDS PA 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:HARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-656-4830
Mailing Address - Street 1:16546 BASTILLE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8304
Mailing Address - Country:US
Mailing Address - Phone:678-656-4830
Mailing Address - Fax:
Practice Address - Street 1:3211 EASTWAY DR STE 10
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6679
Practice Address - Country:US
Practice Address - Phone:704-563-5327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental