Healthcare Provider Details

I. General information

NPI: 1528057619
Provider Name (Legal Business Name): MARIELLA B CONNORS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIELLA BONILLA DMD

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14697 DELAWARE ST UNIT 210
WESTMINSTER CO
80023-9262
US

IV. Provider business mailing address

2809 EAGLE DR
ERIE CO
80516-4002
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-0310
  • Fax:
Mailing address:
  • Phone: 857-654-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number20376
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN.00205516
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401418346
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: