Organization
FORTUNA A. VARDEMAN, DDS, PC
Active
Parent organization
RANDOLPH FAMILY DENTAL
Other names
Randolph Family Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
RANDOLPH FAMILY DENTAL
Authorized official
DR. FORTUNA ALAPAG VARDEMAN D.D.S. (PRESIDENT/OWNER)
(830) 625-1400
Entity
Organization
Contact information
Practice address
651 S WALNUT AVE STE B, NEW BRAUNFELS, TX 78130-5764
(830) 625-1400
(830) 625-9031
Mailing address
651 S WALNUT AVE STE B, NEW BRAUNFELS, TX 78130-5764
(830) 625-1400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18827
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091264401
—
TX
Enumeration date
09/03/2010
Last updated
09/15/2010
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