# 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:** 1659689776
- **Legal business name:** RANDOLPH FAMILY DENTAL
- **Authorized official:** DR. FORTUNA ALAPAG VARDEMAN DDS (OWNER)
- **Authorized official phone:** (210) 658-9031

## Contact information

- **Practice address:** 117 E LANGLEY, UNIVERSAL CITY, TX 78148-4414
- **Practice address phone:** (210) 658-9031
- **Practice address fax:** (210) 658-8202
- **Mailing address:** 117 E LANGLEY, UNIVERSAL CITY, TX 78148-4414
- **Mailing address phone:** (210) 658-9031
- **Mailing address fax:** (210) 658-8202

## Taxonomy

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

## Other

- **Enumeration date:** 09/23/2010
- **Last updated:** 09/23/2010