Provider Demographics
NPI:1679073134
Name:PALLA, BENJAMIN LOUIS (DMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LOUIS
Last Name:PALLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 20TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2090
Mailing Address - Country:US
Mailing Address - Phone:310-453-5330
Mailing Address - Fax:310-453-5326
Practice Address - Street 1:1301 20TH ST STE 400
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2090
Practice Address - Country:US
Practice Address - Phone:310-453-5330
Practice Address - Fax:310-453-5326
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1099261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery