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 1:2124 BIERCE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-7217
Mailing Address - Country:US
Mailing Address - Phone:857-654-2321
Mailing Address - Fax:
Practice Address - Street 1:6224 PORTSMOUTH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-1351
Practice Address - Country:US
Practice Address - Phone:757-500-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002055161223P0221X
MA203761223P0221X
VA04014183461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA20467OtherFIRST SENIORITY
20376OtherDELTA DENTAL
X09081OtherDENTAL BLUE
AA20467OtherHARVARD PILGRIM POS
AA20467OtherHARVARD PILGRIM PPO
0034440OtherNEIGHBORHOOD HEALTH PLAN
20376OtherDELTA DENTAL PREFERRED OPTIO
AA20467OtherHARVARD/PILGRIM