Provider Demographics
NPI:1457177255
Name:MANOHAR, MITHUN KING (MDENT)
Entity type:Individual
Prefix:DR
First Name:MITHUN KING
Middle Name:
Last Name:MANOHAR
Suffix:
Gender:M
Credentials:MDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 OLEANDER CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4224
Mailing Address - Country:US
Mailing Address - Phone:757-470-1914
Mailing Address - Fax:
Practice Address - Street 1:2029 LYNNHAVEN PKWY STE 700
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1489
Practice Address - Country:US
Practice Address - Phone:757-416-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014192341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics