Healthcare Provider Details

I. General information

NPI: 1174447304
Provider Name (Legal Business Name): COURTNEY MADISON GLOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2315 GRACE AVE
NEW BERN NC
28562-4407
US

IV. Provider business mailing address

2315 GRACE AVE
NEW BERN NC
28562-4407
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-2261
  • Fax:
Mailing address:
  • Phone: 252-633-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14940
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: