Laura Fundora Jimenez, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13489627-9921 Issued in UT

Practice address

13686 S Redwood Rd Ste C
Riverton, UT 84065-5907

Phone

(801) 446-8100

NPI assigned

Jul 10, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Professional Dental Riverton LLC

  • Public Health Dentistry
  • Riverton, UT
  • NPI 1902688492
  NPD

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1740968510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13686 S REDWOOD RD STE C",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840655907",
            "telephone_number": "801-446-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13686 S REDWOOD RD STE C",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840655907",
            "telephone_number": "801-446-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDORA JIMENEZ",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "13489627-9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Alan Freeman, DPT
• Stephen Jake Freeman, FNP
• Fresenius Medical Care Riverton, LLC
• Stuart Covington Fry, DMD
• Brenda Fuell, RDH
• David Lee Furuta, PA-C
• David Futrell Jr., CPSS
• Amanda Leigh Gagnon
• Nicholas Gajkowski, MD
• Derrick Cripps Gale, M.D.

• General Practice Dentistry in Riverton, UT
• Providers in Riverton, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.