Healthcare Provider Details

I. General information

NPI: 1538822499
Provider Name (Legal Business Name): CALOSS CENTER FOR FACIAL RECONSTRUCTION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 130
JACKSON MS
39202-2027
US

IV. Provider business mailing address

1200 N STATE ST STE 130
JACKSON MS
39202-2027
US

V. Phone/Fax

Practice location:
  • Phone: 601-841-3223
  • Fax: 601-841-3172
Mailing address:
  • Phone: 601-841-3223
  • Fax: 601-841-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: RONALD CALOSS
Title or Position: OWNER
Credential: DDS, MD
Phone: 601-841-3223