Provider Demographics
NPI:1861093957
Name:JAYARAMAN, JAYAKUMAR (BDS, MDS, MS, PHD)
Entity type:Individual
Prefix:
First Name:JAYAKUMAR
Middle Name:
Last Name:JAYARAMAN
Suffix:
Gender:M
Credentials:BDS, MDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 SPRING MOSS CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3425
Mailing Address - Country:US
Mailing Address - Phone:210-589-2808
Mailing Address - Fax:
Practice Address - Street 1:2924 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1215
Practice Address - Country:US
Practice Address - Phone:804-828-2362
Practice Address - Fax:804-827-1244
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA04014176731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program