MEDICARE: ANTHONY OLATUNJI D.M.D

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	1223G0001X	General Practice Dentistry	19621	MA
2	1223G0001X	General Practice Dentistry	109702	CA

General Provider Information

NPI Number	:	1932267390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY OLATUNJI D.M.D

Provider Business Mailing Address
First Line	:	1510 W ARTESIA SQ APT C
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90248-4768
Country	:	US
Telephone Number	:	781-774-9885
Fax Number	:	310-747-5273

Provider Business Practice Location Address
First Line	:	11900 AVALON BLVD STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2867
Country	:	US
Telephone Number	:	310-331-8134
Fax Number	:	310-747-5273

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	12/23/2025

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