Provider Demographics
NPI:1437310414
Name:KHISTI, MANIK RAHUL (DMD)
Entity Type:Individual
Prefix:MRS
First Name:MANIK
Middle Name:RAHUL
Last Name:KHISTI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5954 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2258
Mailing Address - Country:US
Mailing Address - Phone:804-266-7976
Mailing Address - Fax:
Practice Address - Street 1:5954 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2258
Practice Address - Country:US
Practice Address - Phone:804-266-7976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice