Provider Demographics
NPI:1912006594
Name:VANDERBURG, NIKKO J (DDS)
Entity type:Individual
Prefix:DR
First Name:NIKKO
Middle Name:J
Last Name:VANDERBURG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NIKKO
Other - Middle Name:VANDERBURG
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:625 VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075
Mailing Address - Country:US
Mailing Address - Phone:858-755-9775
Mailing Address - Fax:918-680-3782
Practice Address - Street 1:625 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075
Practice Address - Country:US
Practice Address - Phone:858-755-9775
Practice Address - Fax:918-680-3782
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics