NPIMap

Individual provider Active NPI

Tyler Graham Driggers, DDS

  • Pediatric Dentistry
  • Rome, GA
National Provider Identifier
1255560520
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN014301 Issued in GA
Practice address
15 Riverbend Dr SW Ste 130
Rome, GA 30161-6005
Phone
(706) 232-1283
NPI assigned
Jul 8, 2009
Last updated
Feb 10, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 10471 CO
Pediatric Dentistry 1223P0221X DN014301 GA Primary

Addresses

Primary practice location

15 Riverbend Dr SW Ste 130
Rome, GA 30161-6005

Mailing address

2030 Point Grey CT NW
Kennesaw, GA 30152-8276
Phone (678) 427-6851

Other practice location 1

306 Center Dr
Superior, CO 80027-8625
Phone (303) 494-5437

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN014301GAMDPediatric Dentist
10471COMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Dental Ctr at Brookstone Pediatric Dentistry Past Accepting new patients
MH Dental PC Past Accepting new patients
Children's Dental Center, PC Pediatric Dentistry Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1255560520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 POINT GREY CT NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301528276",
            "telephone_number": "678-427-6851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 RIVERBEND DR SW STE 130",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301616005",
            "telephone_number": "706-232-1283"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "306 Center Dr",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "CO",
            "postal_code": "800278625",
            "country_code": "US",
            "telephone_number": "303-494-5437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DRIGGERS",
        "first_name": "TYLER",
        "middle_name": "GRAHAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-08",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "10471",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN014301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rome, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; 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.