Healthcare Provider Details

I. General information

NPI: 1881687325
Provider Name (Legal Business Name): STEVEN D. NYTKO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19871 MITSCHER WAY BDC MIRAMAR - BLDG. 2495, MCAS MIRAMAR
SAN DIEGO CA
92145-5103
US

IV. Provider business mailing address

1062 TARENTO DR
SAN DIEGO CA
92107-4155
US

V. Phone/Fax

Practice location:
  • Phone: 858-577-1825
  • Fax:
Mailing address:
  • Phone: 619-884-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19022715
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number21001719
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: