Provider Demographics
NPI:1154072999
Name:BOLLAVARAPU, RATNA KAMALAKAR
Entity type:Individual
Prefix:
First Name:RATNA KAMALAKAR
Middle Name:
Last Name:BOLLAVARAPU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2145
Mailing Address - Country:US
Mailing Address - Phone:601-466-8209
Mailing Address - Fax:
Practice Address - Street 1:1335 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3125
Practice Address - Country:US
Practice Address - Phone:417-310-9190
Practice Address - Fax:417-310-9191
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4260-211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice