Provider Demographics
NPI:1386851632
Name:GENE R. GLOVER, DDS, PA
Entity Type:Organization
Organization Name:GENE R. GLOVER, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-243-3223
Mailing Address - Street 1:1706 MEDICAL PARK DR W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2705
Mailing Address - Country:US
Mailing Address - Phone:252-243-3223
Mailing Address - Fax:252-243-3668
Practice Address - Street 1:1706 MEDICAL PARK DR W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2705
Practice Address - Country:US
Practice Address - Phone:252-243-3223
Practice Address - Fax:252-243-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993231Medicaid
NC93231OtherBCBS PROVIDER NUMBER
NC014UUOtherBCBS GROUP NUMBER
NC01497002OtherUNITED CONCORDIA GROUP NO
NC89014UUMedicaid
NC539583OtherUNITED CONCORDIA NUMBER
NC014UUOtherBCBS GROUP NUMBER
NCT32452Medicare UPIN