Provider Demographics
NPI:1073707212
Name:WALLINE, BENJAMIN WILLIAM (DDS, MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:WALLINE
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:#610
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-842-4811
Mailing Address - Fax:310-286-2177
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:#610
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-842-4811
Practice Address - Fax:310-286-2177
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2012-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA98343207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck