Provider Demographics
NPI:1376283010
Name:AMDG DENTAL PLLC
Entity Type:Organization
Organization Name:AMDG DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-527-7037
Mailing Address - Street 1:317 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GOLIAD
Mailing Address - State:TX
Mailing Address - Zip Code:77963-4167
Mailing Address - Country:US
Mailing Address - Phone:361-645-2381
Mailing Address - Fax:
Practice Address - Street 1:317 S MARKET ST
Practice Address - Street 2:
Practice Address - City:GOLIAD
Practice Address - State:TX
Practice Address - Zip Code:77963-4167
Practice Address - Country:US
Practice Address - Phone:361-645-2381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental