NPIMap

Organization Active NPI

Fortuna a Vardeman DDS PC

Doing business as Randolph Family Dental

  • General Practice Dentistry
  • Universal City, TX
National Provider Identifier
1659689776
Registry record updated Sep 23, 2010
On this page

Key facts

NPPES NPI Registry
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
117 E Langley
Universal City, TX 78148-4414
Phone
(210) 658-9031
Fax
(210) 658-8202
NPI assigned
Sep 23, 2010
Last updated
Sep 23, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
RANDOLPH FAMILY DENTALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2010

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

Authorized official

Name
Dr. Fortuna Alapag Vardeman, DDSNPI 1053404897
Title
Owner
Phone
(210) 658-9031

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 18827 TX Primary

Addresses

Primary practice location

117 E Langley
Universal City, TX 78148-4414

Mailing address

117 E Langley
Universal City, TX 78148-4414
Phone (210) 658-9031

Other names 1

  • Randolph Family Dental Doing business as

National Provider Directory

National Provider Directory
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.

Locations

117 E Langley Blvd
Universal City, TX 78148
Phone (210) 658-9031

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285200000000",
    "number": "1659689776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 E LANGLEY",
            "city": "UNIVERSAL CITY",
            "state": "TX",
            "postal_code": "781484414",
            "telephone_number": "210-658-9031",
            "fax_number": "210-658-8202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E LANGLEY",
            "city": "UNIVERSAL CITY",
            "state": "TX",
            "postal_code": "781484414",
            "telephone_number": "210-658-9031",
            "fax_number": "210-658-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTUNA A VARDEMAN DDS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RANDOLPH FAMILY DENTAL",
        "enumeration_date": "2010-09-23",
        "last_updated": "2010-09-23",
        "status": "A",
        "authorized_official_last_name": "VARDEMAN",
        "authorized_official_first_name": "FORTUNA",
        "authorized_official_middle_name": "ALAPAG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-658-9031",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "18827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Randolph Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Universal City, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.