MEDICARE: BESPOKE OMS 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1881557973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BESPOKE OMS PLLC

Provider Business Mailing Address
First Line	:	603 LEXINGTON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4736
Country	:	US
Telephone Number	:	479-310-8008
Fax Number	:	479-310-8009

Provider Business Practice Location Address
First Line	:	603 LEXINGTON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4736
Country	:	US
Telephone Number	:	479-310-8008
Fax Number	:	479-310-8009

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DREW ROBERTS
Credential	:	DDS
Telephone Number	:	479-629-3305

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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Directions to “BESPOKE OMS PLLC ” Practice Location

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