Provider Demographics
NPI:1184789281
Name:DRIGGERS, ISABEL GHOWANLU (DMD)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:GHOWANLU
Last Name:DRIGGERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TANNER FORD BLVD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-4707
Mailing Address - Country:US
Mailing Address - Phone:843-818-5437
Mailing Address - Fax:843-725-1594
Practice Address - Street 1:1000 TANNER FORD BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410-4707
Practice Address - Country:US
Practice Address - Phone:843-818-5437
Practice Address - Fax:843-725-1594
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130761223G0001X
SCSC38891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3889Medicaid
DN013076OtherLICENSE
DN013076OtherLICENSE
BG7872852OtherDEA