Provider Demographics
NPI:1508241993
Name:IAN M. RAE, DMD SMILE INNOVATIONS
Entity Type:Organization
Organization Name:IAN M. RAE, DMD SMILE INNOVATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-879-1321
Mailing Address - Street 1:5150 CEDAR BROOK CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-7405
Mailing Address - Country:US
Mailing Address - Phone:937-879-1321
Mailing Address - Fax:
Practice Address - Street 1:5150 CEDAR BROOK CT
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-7405
Practice Address - Country:US
Practice Address - Phone:937-879-1321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental