Provider Demographics
NPI:1760008403
Name:BOUHOM, VALERIE NGANGOUA (DMD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:NGANGOUA
Last Name:BOUHOM
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 1:8 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1058
Mailing Address - Country:US
Mailing Address - Phone:636-675-0958
Mailing Address - Fax:
Practice Address - Street 1:32 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1638
Practice Address - Country:US
Practice Address - Phone:636-675-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist