Provider Demographics
NPI:1831234202
Name:LAGDA, EVELYN GEGARE (DDS)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:GEGARE
Last Name:LAGDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242-EAST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021
Mailing Address - Country:US
Mailing Address - Phone:858-689-9846
Mailing Address - Fax:858-689-0131
Practice Address - Street 1:1242 - EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021
Practice Address - Country:US
Practice Address - Phone:858-689-9846
Practice Address - Fax:858-689-0131
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist