Provider Demographics
NPI:1386863801
Name:HARLIN, JUSTIN BLAKE (DDS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BLAKE
Last Name:HARLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 S DESERT BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1233
Mailing Address - Country:US
Mailing Address - Phone:915-706-2909
Mailing Address - Fax:
Practice Address - Street 1:6351 S DESERT BLVD STE 210
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1233
Practice Address - Country:US
Practice Address - Phone:915-706-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22480122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice