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General NPI Number Information
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NPI Number | 1366244550
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Entity Type | Organization
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Legal Business Name | CTA ORAL PATHOLOGY CONSULTANTS OF MICHIGAN PLLC
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 3131 S STATE ST STE 309
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City | ANN ARBOR
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State | MI
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Zip | 48108-1658
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Country | US
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Telephone | 503-906-7300
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Fax | 503-245-8219
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Provider Business Mailing Address
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Address Line | PO BOX 230457
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City | PORTLAND
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State | OR
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Zip | 97281-0457
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Country | US
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Telephone | 503-906-7300
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | BRENT ACCURSO
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Credential | DDS
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Telephone | 734-709-5326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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