MEDICARE: EXO DENTAL VAN BUREN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1801738836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXO DENTAL VAN BUREN PLLC

Provider Business Mailing Address
First Line	:	2025 FAYETTEVILLE RD STE B
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-6981
Country	:	US
Telephone Number	:	479-545-1122
Fax Number	:	479-545-1188

Provider Business Practice Location Address
First Line	:	2025 FAYETTEVILLE RD STE B
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-6981
Country	:	US
Telephone Number	:	479-545-1122
Fax Number	:	479-545-1188

Authorized Official
Title or Position	:	OWNER, CEO, DOCTOR
Name	:	DR. JACOB SMITH
Credential	:	DDS
Telephone Number	:	573-380-8867

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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