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Contact Information

CUSTOM CROWNS
5400 S UNIVERSITY DR
DAVIE, FL33328-5312
 Phone: 954-947-0641
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical Laboratory

246RM2200X
 

Clinic/Center

261Q00000X
 

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
 

Community Health

261QC1500X
 

Developmental - Behavioral Pediatrics

2080P0006X 37 Physician/Pediatric Medicine
 

Health Service

261QH0100X
 

Infusion Therapy

261QI0500X
 

Mental Health (Including Community Mental Health Center)

261QM0801X B4[14] Community Mental Health Center
 

Multi-Specialty

261QM1300X 70 Clinic or Group Practice
 

Occupational Medicine

261QX0100X
Indicates primary specialty

NPI Profile & details for CUSTOM CROWNS

NPI # 1538813910
LBN Legal business name CUSTOM CROWNS
Authorized official TYSHAWN MARTIN - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 02/04/2022
Last updated 02/04/2022 - About 4 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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