Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Custom Crowns

Organization Developmental - Behavioral Pediatrics Physician · NPI 1538813910

Custom Crowns is a Developmental - Behavioral Pediatrics Physician in Davie, Florida. Registered with an NPI since 2022.

In the registry since
2022
Specialties on file
11

Practice location Address checks out

5400 S University Dr
Davie, FL 33328-5312
Phone: (954) 947-0641
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Laboratory Technician (primary) Taxonomy 246RM2200X
Developmental - Behavioral Pediatrics Physician Taxonomy 2080P0006X
Clinical Laboratory Director (Non-physician) Taxonomy 247ZC0005X
Clinic/Center Taxonomy 261Q00000X
Community Health Clinic/Center Taxonomy 261QC1500X
Health Service Clinic/Center Taxonomy 261QH0100X
Infusion Therapy Clinic/Center Taxonomy 261QI0500X
Mental Health Clinic/Center (Including Community Mental Health Center) Taxonomy 261QM0801X
Multi-Specialty Clinic/Center Taxonomy 261QM1300X
Occupational Medicine Clinic/Center Taxonomy 261QX0100X
Clinical Medical Laboratory Taxonomy 291U00000X

Record details

NPI number1538813910
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tyshawn Martin — Ceo · (305) 788-7779
NPI enumeratedFebruary 4, 2022
Last updated in NPPESFebruary 4, 2022
Certification dateFebruary 4, 2022
Mailing address5202 Plunkett St, Hollywood, FL 33021-8023

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