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General NPI Number Information
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NPI Number | 1013609197
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Entity Type | Individual
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Provider Name | MATTHEW REY DIAMSE DDS
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Gender | Male
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 9400 BRIER CREEK PKWY STE 204
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City | RALEIGH
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State | NC
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Zip | 27617-6519
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Country | US
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Telephone | 984-477-0177
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Fax |
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Provider Business Mailing Address
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Address Line | 637 AARON CIR
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City | DURHAM
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State | NC
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Zip | 27713-3207
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Country | US
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Telephone | 562-640-1022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13408
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License Number State | NC
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