Active NPI
Jonathan Funtanilla, DMD
- Dentist
- Fort Riley, KS
National Provider Identifier
1760144042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D011205
- Practice address
- 650 Huebner Rd
Fort Riley, KS 66442-4030 - Phone
- (785) 240-7410
- NPI assigned
- Oct 13, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D011205 | AZ | Primary |
Addresses
Primary practice location
650 Huebner Rd
Fort Riley, KS 66442-4030
Mailing address
650 Huebner Rd
Fort Riley, KS 66442-4030
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D011205 | Other | AZ | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D011205 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750636800000",
"number": "1760144042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 HUEBNER RD",
"city": "FORT RILEY",
"state": "KS",
"postal_code": "664424030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 HUEBNER RD",
"city": "FORT RILEY",
"state": "KS",
"postal_code": "664424030",
"telephone_number": "785-240-7410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNTANILLA",
"first_name": "JONATHAN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-10-13",
"last_updated": "2025-06-23",
"certification_date": "2025-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D011205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "D011205",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Riley, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.