Fortuna a. Vardeman, DDS, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18827 Issued in TX

Legal business name

FORTUNA A. VARDEMAN, DDS, PC

Doing business as

Randolph Family Dental

Practice address

651 S Walnut Ave Ste B
New Braunfels, TX 78130-5764

Phone

(830) 625-1400

Fax

(830) 625-9031

NPI assigned

Sep 3, 2010

Organization subpart

Yes

Parent organization

RANDOLPH FAMILY DENTALAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Fortuna Alapag Vardeman, D.D.S.

Title

President/Owner

Phone

(830) 625-1400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Randolph Family Dental Doing business as

Tax ID family

Fortuna a Vardeman DDS PC2 organizations share this tax ID, including this one

Part of

Fortuna a Vardeman DDS PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fortuna a Vardeman DDS PC

  • General Practice Dentistry
  • Universal City, TX
  • NPI 1659689776
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284508800000",
    "number": "1407163900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 S WALNUT AVE STE B",
            "city": "NEW BRAUNFELS",
            "state": "TX",
            "postal_code": "781305764",
            "telephone_number": "830-625-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 S WALNUT AVE STE B",
            "city": "NEW BRAUNFELS",
            "state": "TX",
            "postal_code": "781305764",
            "telephone_number": "830-625-1400",
            "fax_number": "830-625-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTUNA A. VARDEMAN, DDS, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RANDOLPH FAMILY DENTAL",
        "enumeration_date": "2010-09-03",
        "last_updated": "2010-09-15",
        "status": "A",
        "authorized_official_last_name": "VARDEMAN",
        "authorized_official_first_name": "FORTUNA",
        "authorized_official_middle_name": "ALAPAG",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "830-625-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "18827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091264401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Randolph Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Foothill Valley Home Care
• Alyssa Ford
• Katherine Forester, DPT
• Richard Forlano, MD
• Renita Sirena Forney, FNP-BC
• Marie Fouad, MD
• Laura Foulds, LMFT-A
• Foundation Surgery Affiliate of New Braunfels, L.L.P.
• William Fountain
• Four K CDS, LLC

• General Practice Dentistry in New Braunfels, TX
• Providers in New Braunfels, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.