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 1:700 BEVERLY HILLS RD APT 123
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4495
Mailing Address - Country:US
Mailing Address - Phone:601-466-8209
Mailing Address - Fax:
Practice Address - Street 1:4770 AMOCO DR
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-9627
Practice Address - Country:US
Practice Address - Phone:228-474-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4260-211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice