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General NPI Number Information
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NPI Number | 1639217698
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Entity Type | Individual
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Provider Name | IAN MELVILLE RAE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5538 PHILADELPHIA DR
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City | DAYTON
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State | OH
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Zip | 45415-3062
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Country | US
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Telephone | 937-278-0703
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Fax |
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Provider Business Mailing Address
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Address Line | 2281 COBBLESTONE CT
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City | MIAMISBURG
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State | OH
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Zip | 45342-5747
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Country | US
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Telephone | 937-847-9359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30-022135
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License Number State | OH
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