Provider Demographics
NPI:1881687325
Name:NYTKO, STEVEN D (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:NYTKO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 TARENTO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-4155
Mailing Address - Country:US
Mailing Address - Phone:619-884-1992
Mailing Address - Fax:
Practice Address - Street 1:19871 MITSCHER WAY
Practice Address - Street 2:BDC MIRAMAR - BLDG. 2495, MCAS MIRAMAR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145-5103
Practice Address - Country:US
Practice Address - Phone:858-577-1825
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19022715122300000X
IL210017191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0300XDental ProvidersDentistPeriodontics