Healthcare Provider Details

I. General information

NPI: 1174653158
Provider Name (Legal Business Name): BRENT THOMAS ACCURSO DDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 S STATE ST STE 309
ANN ARBOR MI
48108-1658
US

IV. Provider business mailing address

PO BOX 230457
PORTLAND OR
97281-0457
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-7300
  • Fax:
Mailing address:
  • Phone: 503-906-7300
  • Fax: 248-858-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2901019383
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2901019383
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: