Healthcare Provider Details

I. General information

NPI: 1598709701
Provider Name (Legal Business Name): GENE ROBERT GLOVER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 MEDICAL PARK DR W
WILSON NC
27893-2705
US

IV. Provider business mailing address

1706 MEDICAL PARK DR W
WILSON NC
27893-2705
US

V. Phone/Fax

Practice location:
  • Phone: 252-243-3223
  • Fax: 252-243-3668
Mailing address:
  • Phone: 252-243-3223
  • Fax: 252-243-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5216
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: