Grand Legacy Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GRAND LEGACY DENTAL

Practice address

2654 4TH Ave
San Diego, CA 92103-6515

Phone

(619) 234-7493

NPI assigned

Nov 6, 2025

Organization subpart

Yes

Parent organization

EVAN DEMKO DDS INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Evan Demko, DDSNPI 1386010361

Title

Dentist

Phone

(619) 234-7493

Specialties & licenses 1

Addresses

Part of

Grand Legacy Dental

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Evan Demko, DDS

  • Dentist
  • San Diego, CA
  • NPI 1386010361
  NPD Authorized official
• John Cletus Deal, DDS

  • Dentist
  • San Diego, CA
  • NPI 1447318837
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762387200000",
    "number": "1932079878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2654 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921036515",
            "telephone_number": "619-234-7493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2654 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921036515",
            "telephone_number": "619-234-7493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LEGACY DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVAN DEMKO DDS INC",
        "enumeration_date": "2025-11-06",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A",
        "authorized_official_last_name": "DEMKO",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "619-234-7493",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alani Granados
• Blanca Granados
• Christopher Granados
• Erika Guadalupe Granados
• Caroline Cortes Granadosin, RN
• Aimee Grand
• Paul Jefferson Grand
• Christopher Scott Granda, DO
• Edna Alejandra Granda
• Grandcare San Diego, LLC

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.