Provider Demographics
NPI:1932157500
Name:CALOSS, RON JR (DDS, MD)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:CALOSS
Suffix:JR
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248871
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8871
Mailing Address - Country:US
Mailing Address - Phone:877-667-7669
Mailing Address - Fax:888-920-7457
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2000
Practice Address - Country:US
Practice Address - Phone:662-391-4797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17892122300000X
MS17730 3477-08,05411-1223S0112X
MSOS41108204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN165622501Medicaid
TX8B6700Medicare ID - Type Unspecified
H68661Medicare UPIN
302I193987Medicare PIN