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General NPI Number Information
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NPI Number | 1255560520
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Entity Type | Individual
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Provider Name | TYLER GRAHAM DRIGGERS DDS
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Gender | Male
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 15 RIVERBEND DR SW STE 130
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City | ROME
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State | GA
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Zip | 30161-6005
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Country | US
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Telephone | 706-232-1283
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 POINT GREY CT NW
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City | KENNESAW
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State | GA
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Zip | 30152-8276
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Country | US
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Telephone | 678-427-6851
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10471
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN014301
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License Number State | GA
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