MEDICARE: SMILE TRUST DENTAL GROUP INC

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	:	1194672097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE TRUST DENTAL GROUP INC

Provider Business Mailing Address
First Line	:	4200 W CYPRESS ST STE 690
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-4112
Country	:	US
Telephone Number	:	800-221-0401
Fax Number	:	863-312-3707

Provider Business Practice Location Address
First Line	:	205 1ST ST S
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3255
Country	:	US
Telephone Number	:	800-221-0401
Fax Number	:	863-312-3707

Authorized Official
Title or Position	:	CEO
Name	:	HUMBERTO DE JESUS VAZQUEZ
Credential	:	DDS
Telephone Number	:	800-221-0401

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

Similar Medicare Providers

1497362842 — AMARILIS AGUILERA
Practice Location Address:

205 1ST ST S
WINTER HAVEN, FL
33880-3255

Practice Phone: 863-877-0064
Practice Fax:

1114684123 — ODALYS BARCELO
Practice Location Address:

205 1ST ST S
WINTER HAVEN, FL
33880-3255

Practice Phone: 305-534-0076
Practice Fax:

1760134126 — LA FORTALEZA PHYSICAL THERAPY CENTER INC
Practice Location Address:

205 1ST ST S STE 103-104
WINTER HAVEN, FL
33880-3255

Practice Phone: 863-875-8355
Practice Fax:

1336969567 — KEILA GABRIELA DIAZ LCSW
Practice Location Address:

16 S LAKE FOX RD
WINTER HAVEN, FL
33884-3255

Practice Phone: 689-243-8086
Practice Fax:

1235991738 — TAHJEAH MCCLAIN
Practice Location Address:

26 COLEMAN ST APT K
WEST HAVEN, CT
06516-3255

Practice Phone: 203-501-2838
Practice Fax:

1497402440 — ABRAHAM DOMINGUEZ-WILLIAMS
Practice Location Address:

16930 TRADEWIND PT
WINTER GARDEN, FL
34787-3255

Practice Phone: 646-455-7038
Practice Fax:

Directions to “SMILE TRUST DENTAL GROUP INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.