=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376664318
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RALPH A CALLENDER III DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2650 BEACH BLVD
-----------------------------------------------------
City | BILOXI
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39531-4517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-400-4722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11615 HIGHWAY 70 STE 108B
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38002-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-546-1925
-----------------------------------------------------
Fax | 800-420-5168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 35230
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | OR-6084-25
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------