Provider Demographics
NPI:1932267390
Name:OLATUNJI, ANTHONY (DMD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:OLATUNJI
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 1:1510 W ARTESIA SQ APT C
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4768
Mailing Address - Country:US
Mailing Address - Phone:781-774-9885
Mailing Address - Fax:310-747-5273
Practice Address - Street 1:11900 AVALON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2867
Practice Address - Country:US
Practice Address - Phone:310-331-8134
Practice Address - Fax:310-747-5273
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2025-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196211223G0001X
CA1097021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice