MEDICARE: SMILES OF WINTER HAVEN, PLLC

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

General Provider Information

NPI Number	:	1063349421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILES OF WINTER HAVEN, PLLC

Provider Business Mailing Address
First Line	:	3448 CLEVELAND AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7108
Country	:	US
Telephone Number	:	239-936-3436
Fax Number	:

Provider Business Practice Location Address
First Line	:	5535 CYPRESS GARDENS BLVD STE 120
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-2211
Country	:	US
Telephone Number	:	863-326-1600
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE CONTRACTING MANAGER
Name	:	TAMMIE STEPHENS
Credential	:
Telephone Number	:	239-936-3436

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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