Provider Demographics
NPI:1023490869
Name:BELLAMA, MARY (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:BELLAMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WINTONBURY MALL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2412
Mailing Address - Country:US
Mailing Address - Phone:860-242-1230
Mailing Address - Fax:
Practice Address - Street 1:42 WINTONBURY MALL
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2412
Practice Address - Country:US
Practice Address - Phone:860-242-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-28
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT134631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice