Active NPI
Donald Basil Drevna, D.M.D.
- Dentist
- San Diego, CA
National Provider Identifier
1508076498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 954726363
- Practice address
- 4166 Monroe Ave
Unit #1
San Diego, CA 92116-4773 - Phone
- (760) 550-0059
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 954726363 | CA | Primary |
Addresses
Primary practice location
4166 Monroe Ave
Unit #1
San Diego, CA 92116-4773
Mailing address
4166 Monroe Ave
Unit #1
San Diego, CA 92116-4773
Phone (760) 550-0059
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 954726363 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391644800000",
"number": "1508076498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4166 MONROE AVE",
"address_2": "UNIT #1",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921164773",
"telephone_number": "760-550-0059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4166 MONROE AVE",
"address_2": "UNIT #1",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921164773",
"telephone_number": "760-550-0059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DREVNA",
"first_name": "DONALD",
"middle_name": "BASIL",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2014-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "954726363",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.