MEDICARE: DR. ABIOLA C OLADELE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	109620	CA

General Provider Information

NPI Number	:	1588430581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABIOLA C OLADELE DDS

Provider Business Mailing Address
First Line	:	1200 S GRAND AVE APT 330
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 S WESTERN AVE STE J
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-4200
Country	:	US
Telephone Number	:	323-529-9066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	02/13/2024

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