MEDICARE: CTA ORAL PATHOLOGY CONSULTANTS OF MICHIGAN, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry

General Provider Information

NPI Number	:	1366244550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CTA ORAL PATHOLOGY CONSULTANTS OF MICHIGAN, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3227
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77253-3227
Country	:	US
Telephone Number	:	503-906-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 S STATE ST STE 307
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1658
Country	:	US
Telephone Number	:	503-906-7300
Fax Number	:	503-245-8219

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	BRENT ACCURSO
Credential	:	DDS
Telephone Number	:	734-709-5326

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	02/04/2026

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