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Custom Crowns
NPI 1538813910 · Medical Laboratory Technician · Davie, FL
Provider details
- NPI number
- 1538813910
- Entity type
- Organization
- Primary specialty
- Medical Laboratory TechnicianTechnologists, Technicians & Other Technical Service Providers
- Organization subpart
- No
- Authorized official
- Tyshawn Martin, Ceo(305) 788-7779
Specialties & taxonomies
Technologists, Technicians & Other Technical Service Providers
Allopathic & Osteopathic Physicians
Technologists, Technicians & Other Technical Service Providers
- Clinic/Center261Q00000X
Ambulatory Health Care Facilities
- Community Health Clinic/Center261QC1500X
Ambulatory Health Care Facilities
- Health Service Clinic/Center261QH0100X
Ambulatory Health Care Facilities
Practice location
5400 S University Dr
Davie, FL 33328-5312
Phone: (954) 947-0641
Approximate (ZIP-level) locationGet directions
Mailing address
5202 Plunkett St
Hollywood, FL 33021-8023
Registry dates
- Enumerated
- 2022-02-04
- Last updated
- 2022-02-04
- Certified
- 2022-02-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.