NPIMap

Organization Active NPI

Custom Crowns

  • Medical Laboratory Technician
  • Davie, FL
National Provider Identifier
1538813910
Registry record updated Feb 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Laboratory TechnicianTaxonomy code 246RM2200X
Legal business name
CUSTOM CROWNS
Practice address
5400 S University Dr
Davie, FL 33328-5312
Phone
(954) 947-0641
NPI assigned
Feb 4, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2022

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

Authorized official

Name
Tyshawn MartinNPI 1255963450
Title
Ceo
Phone
(305) 788-7779

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0006X
Medical Laboratory TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 246RM2200X Primary
Clinical Laboratory Director (Non-physician)Group: 193200000X MULTI-SPECIALTY GROUP 247ZC0005X
Clinic/Center 261Q00000X
Community Health Clinic/Center 261QC1500X
Health Service Clinic/Center 261QH0100X
Infusion Therapy Clinic/Center 261QI0500X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X
Occupational Medicine Clinic/Center 261QX0100X
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

5400 S University Dr
Davie, FL 33328-5312

Mailing address

5202 Plunkett St
Hollywood, FL 33021-8023
Phone (305) 788-7779

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@healthandhairloss.com Direct

National Provider Directory

National Provider Directory

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": "1643932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643932800000",
    "number": "1538813910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5202 PLUNKETT ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218023",
            "telephone_number": "305-788-7779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 S UNIVERSITY DR",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333285312",
            "telephone_number": "954-947-0641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM CROWNS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-04",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "TYSHAWN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-788-7779"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "246RM2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Pathology, Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "247ZC0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Pathology, Clinical Laboratory Director, Non-physician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@healthandhairloss.com",
            "affiliation": "N",
            "endpointDescription": "G-suite",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5400 S University Dr",
            "city": "Davie",
            "state": "FL",
            "country_code": "US",
            "postal_code": "333285312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; 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.