Healthcare Provider Details

I. General information

NPI: 1255184164
Provider Name (Legal Business Name): DR. ANTHONY OLATUNJI SMILES DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 AVALON BLVD STE 101
LOS ANGELES CA
90061-2867
US

IV. Provider business mailing address

1510 W ARTESIA SQ APT C
GARDENA CA
90248-4768
US

V. Phone/Fax

Practice location:
  • Phone: 310-331-8134
  • Fax:
Mailing address:
  • Phone: 781-774-9885
  • Fax: 310-747-5273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY OYEBODE OLATUNJI
Title or Position: DENTIST
Credential: D.M.D
Phone: 781-774-9885