Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI # | 1538822499 |
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| LBN Legal business name | CALOSS CENTER FOR FACIAL RECONSTRUCTION PLLC | ||||
| Authorized official | RONALD CALOSS - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 10/18/2021 | ||||
| Last updated | 07/29/2025 - About 10 months ago | ||||
| Identifiers |
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