Healthcare Provider Details

I. General information

NPI: 1235062209
Provider Name (Legal Business Name): JACOB MICHAEL PURIFOY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 MALVERN AVE
HOT SPRINGS AR
71901-7753
US

IV. Provider business mailing address

1919 MALVERN AVE
HOT SPRINGS AR
71901-7753
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-2778
  • Fax: 501-321-9774
Mailing address:
  • Phone: 501-624-2778
  • Fax: 501-321-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4933
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: