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General NPI Number Information
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NPI Number | 1457177255
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Entity Type | Individual
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Provider Name | MITHUN KING MANOHAR M.DENT
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Gender | Male
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 01/05/2025
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Provider Practice Location Address
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Address Line | 2029 LYNNHAVEN PKWY STE 700
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-1489
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Country | US
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Telephone | 757-416-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 657 OLEANDER CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4224
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Country | US
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Telephone | 757-470-1914
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401419234
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License Number State | VA
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