Provider Demographics
NPI:1871950816
Name:IAN M RAE DMD SMILE INNOVATIONS INC
Entity type:Organization
Organization Name:IAN M RAE DMD SMILE INNOVATIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-879-1321
Mailing Address - Street 1:400 E DAYTON YELLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4064
Mailing Address - Country:US
Mailing Address - Phone:937-879-1321
Mailing Address - Fax:614-407-9580
Practice Address - Street 1:400 E DAYTON YELLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4064
Practice Address - Country:US
Practice Address - Phone:937-879-1321
Practice Address - Fax:614-407-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies