GRAND LEGACY DENTAL
NPI 1932079878
Dentist - General Practice in San Diego, CA

Q: What is Grand Legacy Dental's NPI number?

The NPI number for Grand Legacy Dental is 1932079878. It was assigned to this organization in the NPPES registry on November 6, 2025.

Q: What is Grand Legacy Dental's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since November 06, 2025

2654 4TH AVE, SAN DIEGO, CA 92103(619) 234-7493 Get Directions Write a Review

NPPES record last updated: November 6, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Grand Legacy Dental NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAND LEGACY DENTAL (NPI 1932079878) is a healthcare organization registered as a general practice in San Diego, California and active in the NPI registry since November 2025. The organization lists Evan Demko, Dentist, as its authorized official.

NPPES Registry Identity

NPI1932079878

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameGRAND LEGACY DENTAL

Location Address2654 4TH AVESan Diego, CA 92103-6515

Mailing Address2654 4th AveSan Diego, CA 92103-6515 · (619) 234-7493

Phone(619) 234-7493

Organization SubpartYesParent: Evan Demko Dds Inc

Authorized OfficialEvan DemkoDentist · (619) 234-7493

Enumeration DateNovember 6, 2025

NPPES CertifiedNovember 6, 2025

✔ NPI 1932079878 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

2654 4TH AVE, San Diego, CA 92103

Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. EVAN DEMKO DDS

Dentist

2654 4TH AVE
SAN DIEGO, CA 92103

San Diego County (619) 234-7493

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grand Legacy Dental's NPI number?

The NPI number for Grand Legacy Dental is 1932079878. It was assigned to this organization in the NPPES registry on November 6, 2025.

Where is Grand Legacy Dental located?

Grand Legacy Dental is located at 2654 4th Ave, San Diego, CA 92103. The listed phone number is (619) 234-7493.

What is Grand Legacy Dental's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Grand Legacy Dental was last updated on November 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.