Provider Demographics
NPI:1346470150
Name:JAMIE Y DRIGGERS DMD INC.
Entity Type:Organization
Organization Name:JAMIE Y DRIGGERS DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:YATES
Authorized Official - Last Name:DRIGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-567-3175
Mailing Address - Street 1:133 CEDAR STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT STEPHEN
Mailing Address - State:SC
Mailing Address - Zip Code:29479-0760
Mailing Address - Country:US
Mailing Address - Phone:843-567-3175
Mailing Address - Fax:843-567-3293
Practice Address - Street 1:133 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:SAINT STEPHEN
Practice Address - State:SC
Practice Address - Zip Code:29479-0760
Practice Address - Country:US
Practice Address - Phone:843-567-3175
Practice Address - Fax:843-567-3293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1356504997Medicaid