Provider Demographics
NPI:1598709701
Name:GLOVER, GENE ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:ROBERT
Last Name:GLOVER
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 1:1706 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993231Medicaid
NC2428460Medicare ID - Type Unspecified
NC8993231Medicaid