Healthcare Provider Details

I. General information

NPI: 1801738836
Provider Name (Legal Business Name): EXO DENTAL VAN BUREN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 FAYETTEVILLE RD STE B
VAN BUREN AR
72956-6981
US

IV. Provider business mailing address

2025 FAYETTEVILLE RD STE B
VAN BUREN AR
72956-6981
US

V. Phone/Fax

Practice location:
  • Phone: 479-545-1122
  • Fax: 479-545-1188
Mailing address:
  • Phone: 479-545-1122
  • Fax: 479-545-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB SMITH
Title or Position: OWNER, CEO, DOCTOR
Credential: DDS
Phone: 573-380-8867