Provider Demographics
NPI:1598927196
Name:HERAM, ASHRAF R (MD, BDS,)
Entity Type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:R
Last Name:HERAM
Suffix:
Gender:M
Credentials:MD, BDS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 DOUG WHITE DR STE 430
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4182
Mailing Address - Country:US
Mailing Address - Phone:843-903-6459
Mailing Address - Fax:843-839-0218
Practice Address - Street 1:920 DOUG WHITE DR STE 430
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4182
Practice Address - Country:US
Practice Address - Phone:843-903-6459
Practice Address - Fax:843-839-0218
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138798204E00000X
SC86996204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery