Healthcare Provider Details

I. General information

NPI: 1043061336
Provider Name (Legal Business Name): DR. JAYARAMAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11551 NUCKOLS RD STE H
GLEN ALLEN VA
23059-5565
US

IV. Provider business mailing address

11551 NUCKOLS RD STE H
GLEN ALLEN VA
23059-5565
US

V. Phone/Fax

Practice location:
  • Phone: 804-495-8750
  • Fax: 804-495-8751
Mailing address:
  • Phone: 804-495-8750
  • Fax: 804-495-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAYAKUMAR JAYARAMAN
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 210-589-2808