Provider Demographics
NPI:1932157500
Name:CALOSS, RONALD JR (DDS, MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:CALOSS
Suffix:JR
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:RON
Other - Middle Name:
Other - Last Name:CALOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MD
Mailing Address - Street 1:1200 N STATE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2027
Mailing Address - Country:US
Mailing Address - Phone:601-841-3223
Mailing Address - Fax:601-841-3172
Practice Address - Street 1:1200 N STATE ST STE 130
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2027
Practice Address - Country:US
Practice Address - Phone:601-841-3223
Practice Address - Fax:601-841-3172
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3477-08122300000X
MS17730204E00000X
MSOS-411081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS005871393Medicaid
MS009150891Medicaid
H68661Medicare UPIN
302I193987Medicare PIN