Healthcare Provider Details

I. General information

NPI: 1063349421
Provider Name (Legal Business Name): SMILES OF WINTER HAVEN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 CYPRESS GARDENS BLVD STE 120
WINTER HAVEN FL
33884-2211
US

IV. Provider business mailing address

3448 CLEVELAND AVE
FORT MYERS FL
33901-7108
US

V. Phone/Fax

Practice location:
  • Phone: 863-326-1600
  • Fax:
Mailing address:
  • Phone: 239-936-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TAMMIE STEPHENS
Title or Position: INSURANCE CONTRACTING MANAGER
Credential:
Phone: 239-936-3436