Provider Demographics
NPI:1376664318
Name:CALLENDER, RALPH A III (DDS)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:A
Last Name:CALLENDER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 HIGHWAY 70 STE 108B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-2910
Mailing Address - Country:US
Mailing Address - Phone:901-546-1925
Mailing Address - Fax:800-420-5168
Practice Address - Street 1:2650 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4517
Practice Address - Country:US
Practice Address - Phone:228-400-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352301223X0400X
MSOR-6084-251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS10017-25OtherDENTAL BOARD OF MISSISSIPPI
CAD35230Medicaid
MSOR-6084-25OtherORTHODONTIC SPECIALTY LICENSE
CAB35230Medicaid