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General NPI Number Information
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NPI Number | 1194672097
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Entity Type | Organization
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Legal Business Name | SMILE TRUST DENTAL GROUP INC
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 205 1ST ST S
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3255
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Country | US
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Telephone | 800-221-0401
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Fax | 863-312-3707
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Provider Business Mailing Address
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Address Line | 4200 W CYPRESS ST STE 690
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City | TAMPA
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State | FL
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Zip | 33607-4112
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Country | US
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Telephone | 800-221-0401
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Fax | 863-312-3707
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Authorized Official
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Title or Position | CEO
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Name | HUMBERTO DE JESUS VAZQUEZ
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Credential | DDS
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Telephone | 800-221-0401
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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 |
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License Number State |
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