Organization Active NPI

Smile Trust Dental Group Inc

  • General Practice Dentistry
  • Winter Haven, FL
National Provider Identifier
1194672097
Registry record updated Mar 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SMILE TRUST DENTAL GROUP INC
Practice address
205 1St St S
Winter Haven, FL 33880-3255
Phone
(800) 221-0401
Fax
(863) 312-3707
NPI assigned
Mar 11, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Humberto De Jesus Vazquez, DDS
Title
Ceo
Phone
(800) 221-0401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

205 1St St S
Winter Haven, FL 33880-3255

Mailing address

4200 W Cypress St Ste 690
Tampa, FL 33607-4112
Phone (800) 221-0401

National Provider Directory

National Provider Directory
Tax ID family
Smile Trust Dental Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

205 1st St S
Winter Haven, FL 33880
Phone (863) 821-0021

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1773187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773187200000",
    "number": "1194672097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 W CYPRESS ST STE 690",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336074112",
            "telephone_number": "800-221-0401",
            "fax_number": "863-312-3707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 1ST ST S",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803255",
            "telephone_number": "800-221-0401",
            "fax_number": "863-312-3707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE TRUST DENTAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-11",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A",
        "authorized_official_last_name": "VAZQUEZ",
        "authorized_official_first_name": "HUMBERTO",
        "authorized_official_middle_name": "DE JESUS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "800-221-0401",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.