# INDIANA DENTAL SLEEP THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Koala Center for Sleep Disorders IN-2
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134596869
- **Authorized official:** DR. SHANE COPE DDS, MSD (OWNER)
- **Authorized official phone:** (317) 640-7907

## Contact information

- **Practice address:** 4921 SR 26 E, SUITE 300, LAFAYETTE, IN 47905
- **Practice address phone:** (309) 243-8980
- **Mailing address:** 4921 SR 26 E, SUITE 300, LAFAYETTE, IN 47905

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12011052A | IN | Yes |

## Other

- **Enumeration date:** 08/28/2015
- **Last updated:** 05/16/2016