Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Grand Legacy Dental

Organization General Practice Dentistry · NPI 1932079878

Grand Legacy Dental is a General Practice Dentistry in San Diego, California. Registered with an NPI since 2025.

In the registry since
2025

Practice location Address checks out

2654 4th Ave
San Diego, CA 92103-6515
Phone: (619) 234-7493
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X

Record details

NPI number1932079878
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationEvan Demko DDS Inc
Authorized official Evan Demko — Dentist · (619) 234-7493
NPI enumeratedNovember 6, 2025
Last updated in NPPESNovember 6, 2025
Certification dateNovember 6, 2025
Mailing address2654 4th Ave, San Diego, CA 92103-6515

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