Healthcare Provider Details

I. General information

NPI: 1881557973
Provider Name (Legal Business Name): BESPOKE OMS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 LEXINGTON AVE
FORT SMITH AR
72901-4736
US

IV. Provider business mailing address

603 LEXINGTON AVE
FORT SMITH AR
72901-4736
US

V. Phone/Fax

Practice location:
  • Phone: 479-310-8008
  • Fax: 479-310-8009
Mailing address:
  • Phone: 479-310-8008
  • Fax: 479-310-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. DREW ROBERTS
Title or Position: OWNER
Credential: DDS
Phone: 479-629-3305