MEDICARE: STEVEN D. NYTKO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	19022715	IL
2	1223P0300X	Periodontics	21001719	IL

General Provider Information

NPI Number	:	1881687325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN D. NYTKO D.D.S.

Provider Business Mailing Address
First Line	:	1062 TARENTO DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-4155
Country	:	US
Telephone Number	:	619-884-1992
Fax Number	:

Provider Business Practice Location Address
First Line	:	19871 MITSCHER WAY
Second Line	:	BDC MIRAMAR - BLDG. 2495, MCAS MIRAMAR
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-5103
Country	:	US
Telephone Number	:	858-577-1825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	09/11/2025

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