Provider Demographics
NPI:1366244550
Name:CTA ORAL PATHOLOGY CONSULTANTS OF MICHIGAN PLLC
Entity type:Organization
Organization Name:CTA ORAL PATHOLOGY CONSULTANTS OF MICHIGAN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ACCURSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-709-5326
Mailing Address - Street 1:PO BOX 230457
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97281-0457
Mailing Address - Country:US
Mailing Address - Phone:503-906-7300
Mailing Address - Fax:
Practice Address - Street 1:3131 S STATE ST STE 309
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1658
Practice Address - Country:US
Practice Address - Phone:503-906-7300
Practice Address - Fax:503-245-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty