Provider Demographics
NPI:1427374750
Name:DRIGGERS, CHANDRA TWEET (DDS)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:TWEET
Last Name:DRIGGERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3997 VALLEY COMMONS DR STE A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5617
Mailing Address - Country:US
Mailing Address - Phone:406-404-1186
Mailing Address - Fax:
Practice Address - Street 1:3997 VALLEY COMMONS DR STE A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5617
Practice Address - Country:US
Practice Address - Phone:406-404-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-15498122300000X, 1223G0001X
NMDO3438390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7133568Medicaid