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General NPI Number Information
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NPI Number | 1063856912
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Entity Type | Individual
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Provider Name | JACOB OLIVER SMITH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2013
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 4307 S PLEASANT CROSSING BLVD STE 103
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City | ROGERS
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State | AR
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Zip | 72758-1347
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Country | US
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Telephone | 479-553-9215
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Fax |
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Provider Business Mailing Address
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Address Line | 609 SE HENDRIX ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-4166
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Country | US
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Telephone | 573-380-8867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2012019405
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4412
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License Number State | AR
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