Matthew Edward Imbrogno, DMD, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

11944 Issued in NC

Practice address

4106 Wake Forest Rd Ste 100
Raleigh, NC 27609-6397

Phone

(919) 876-2464

Fax

(919) 876-1409

NPI assigned

Feb 9, 2020

Last updated

Feb 4, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lane and Associates XII DDS PA

  • General Practice Dentistry
  • Raleigh, NC
  • NPI 1811041700
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738627200000",
    "number": "1811529746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 JUNIPER ISLAND DR",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324333516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 WAKE FOREST RD STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096397",
            "telephone_number": "919-876-2464",
            "fax_number": "919-876-1409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMBROGNO",
        "first_name": "MATTHEW",
        "middle_name": "EDWARD",
        "credential": "DMD, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-09",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NC",
            "license": "11944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Periodontics in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.