Provider Demographics
NPI:1467951806
Name:HARLAN, TAYLOR (DDS)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:HARLAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4829
Mailing Address - Country:US
Mailing Address - Phone:239-877-6912
Mailing Address - Fax:
Practice Address - Street 1:407 NC-16 BUS HWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-2664
Practice Address - Country:US
Practice Address - Phone:704-966-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-11
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0256931223P0221X, 122300000X
NC119131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0343743Medicaid