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Organization

CUSTOM CROWNS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TYSHAWN MARTIN (FOUNDER/ CEO)
(305) 788-7779
Entity
Organization

Contact information

Practice address
5202 PLUNKETT ST, HOLLYWOOD, FL 33021-8023
(754) 581-8402
Mailing address
5202 PLUNKETT ST, HOLLYWOOD, FL 33021-8023
(305) 788-7779

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
332BC3200X
Customized Equipment (DME)
Primary

Other

Enumeration date
06/26/2018
Last updated
06/26/2018
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