Provider Demographics
NPI:1437344934
Name:DRAGNEVA, EVELINA IVANOVA (DMD)
Entity Type:Individual
Prefix:DR
First Name:EVELINA
Middle Name:IVANOVA
Last Name:DRAGNEVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11040 BOLLINGER CANYON RD STE I
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5056
Mailing Address - Country:US
Mailing Address - Phone:925-648-8881
Mailing Address - Fax:
Practice Address - Street 1:11040 BOLLINGER CANYON RD STE I
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5056
Practice Address - Country:US
Practice Address - Phone:925-648-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-08
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1011271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice