| Randolph Family Dental | |
|
651 S Walnut Ave Ste B New Braunfels TX 78130-5764 | |
| (830) 625-1400 | |
| (830) 625-9031 |
| Full Name | Randolph Family Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 651 S Walnut Ave Ste B, New Braunfels, Texas |
| Authorized Official Name and Position | Fortuna Alapag Vardeman (PRESIDENT/OWNER) |
| Authorized Official Contact | 8306251400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Randolph Family Dental 651 S Walnut Ave Ste B New Braunfels TX 78130-5764 Ph: (830) 625-1400 | Randolph Family Dental 651 S Walnut Ave Ste B New Braunfels TX 78130-5764 Ph: (830) 625-1400 |
| NPI Number | 1407163900 |
|---|---|
| Provider Enumeration Date | 09/03/2010 |
| Last Update Date | 09/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407163900 | NPI | - | NPPES |
| 091264401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 18827 (Texas) | Primary |
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