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General NPI Number Information
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NPI Number | 1871950816
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Entity Type | Organization
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Legal Business Name | IAN M RAE DMD SMILE INNOVATIONS INC
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 400 E DAYTON YELLOW SPRINGS RD
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City | FAIRBORN
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State | OH
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Zip | 45324-4064
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Country | US
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Telephone | 937-879-1321
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Fax | 614-407-9580
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Provider Business Mailing Address
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Address Line | 400 E DAYTON YELLOW SPRINGS RD
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City | FAIRBORN
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State | OH
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Zip | 45324-4064
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Country | US
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Telephone | 937-879-1321
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Fax | 614-407-9580
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Authorized Official
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Title or Position | OWNER
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Name | IAN RAE
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Credential | DDS
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Telephone | 937-879-1321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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