Provider Demographics
NPI:1891275111
Name:BHOWMICK, GOUTOM KUMAR SAHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GOUTOM
Middle Name:KUMAR SAHA
Last Name:BHOWMICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 TIDE MILL LN APT 15B
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2725
Mailing Address - Country:US
Mailing Address - Phone:347-255-0954
Mailing Address - Fax:
Practice Address - Street 1:2040 COLISEUM DR # A27
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3200
Practice Address - Country:US
Practice Address - Phone:312-274-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014162261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice