# FORTUNA A. VARDEMAN, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** RANDOLPH FAMILY DENTAL
- **Other names:** Randolph Family Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1407163900
- **Legal business name:** RANDOLPH FAMILY DENTAL
- **Authorized official:** DR. FORTUNA ALAPAG VARDEMAN D.D.S. (PRESIDENT/OWNER)
- **Authorized official phone:** (830) 625-1400

## Contact information

- **Practice address:** 651 S WALNUT AVE STE B, NEW BRAUNFELS, TX 78130-5764
- **Practice address phone:** (830) 625-1400
- **Practice address fax:** (830) 625-9031
- **Mailing address:** 651 S WALNUT AVE STE B, NEW BRAUNFELS, TX 78130-5764
- **Mailing address phone:** (830) 625-1400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 18827 | TX | Yes |

## Other

- **Enumeration date:** 09/03/2010
- **Last updated:** 09/15/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 091264401 | — | TX |