MEDICARE: DR. JAYARAMAN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist
2	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1043061336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JAYARAMAN PLLC

Provider Business Mailing Address
First Line	:	11551 NUCKOLS RD STE H
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5565
Country	:	US
Telephone Number	:	804-495-8750
Fax Number	:	804-495-8751

Provider Business Practice Location Address
First Line	:	11551 NUCKOLS RD STE H
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5565
Country	:	US
Telephone Number	:	804-495-8750
Fax Number	:	804-495-8751

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. JAYAKUMAR JAYARAMAN
Credential	:	DMD
Telephone Number	:	210-589-2808

Provider Enumeration Date	:	03/27/2024
Last Update Date	:	06/06/2026

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