Healthcare Provider Details

I. General information

NPI: 1548165715
Provider Name (Legal Business Name): JUSTIN HARLOW DDS PA 4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 GLENWATER DR STE 108
CHARLOTTE NC
28262-8593
US

IV. Provider business mailing address

16546 BASTILLE DR
CHARLOTTE NC
28278-8304
US

V. Phone/Fax

Practice location:
  • Phone: 704-549-1199
  • Fax:
Mailing address:
  • Phone: 704-549-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: HOWARD JUSTIN HARLOW
Title or Position: PRESIDENT
Credential: DDS
Phone: 704-549-1199