Provider Demographics
NPI:1528057619
Name:CONNORS, MARIELLA B (DMD)
Entity type:Individual
Prefix:
First Name:MARIELLA
Middle Name:B
Last Name:CONNORS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARIELLA
Other - Middle Name:
Other - Last Name:BONILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:450 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1172
Mailing Address - Country:US
Mailing Address - Phone:781-784-2565
Mailing Address - Fax:
Practice Address - Street 1:450 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1172
Practice Address - Country:US
Practice Address - Phone:781-784-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA20467OtherHARVARD PILGRIM PPO
20376OtherDELTA DENTAL
0034440OtherNEIGHBORHOOD HEALTH PLAN
X09081OtherDENTAL BLUE
AA20467OtherHARVARD PILGRIM POS
20376OtherDELTA DENTAL PREFERRED OPTIO
AA20467OtherFIRST SENIORITY
AA20467OtherHARVARD/PILGRIM