MEDICARE: JACOB NICHOLAS AUPREY

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	1223G0001X	General Practice Dentistry	4637	AR

General Provider Information

NPI Number	:	1437876943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB NICHOLAS AUPREY

Provider Business Mailing Address
First Line	:	2109 RANNOCH TRCE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-0977
Country	:	US
Telephone Number	:	479-414-9148
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 S 79TH ST STE 100
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6250
Country	:	US
Telephone Number	:	479-242-3340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	10/25/2022

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