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General NPI Number Information
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NPI Number | 1205745759
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Entity Type | Individual
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Provider Name | KELSEY DIAZ DDS
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Gender | Female
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 7839 IDLEWILD RD
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City | CHARLOTTE
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State | NC
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Zip | 28212-5845
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Country | US
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Telephone | 704-778-1204
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Fax |
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Provider Business Mailing Address
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Address Line | 5009 HEMBY RD
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City | MATTHEWS
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State | NC
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Zip | 28104-7712
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 11560
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14760
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License Number State | NC
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