Provider Demographics
NPI:1013609197
Name:DIAMSE, MATTHEW REY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:REY
Last Name:DIAMSE
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 1:637 AARON CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-3207
Mailing Address - Country:US
Mailing Address - Phone:562-640-1022
Mailing Address - Fax:
Practice Address - Street 1:9400 BRIER CREEK PKWY STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6519
Practice Address - Country:US
Practice Address - Phone:984-477-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC134081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program