# SHANE T COPE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Highland Creek Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750724613
- **Authorized official:** DR. SHANE T COPE DDS (OWNER)
- **Authorized official phone:** (765) 807-0592

## Contact information

- **Practice address:** 4921 STATE ROAD 26 E, SUITE 100, LAFAYETTE, IN 47905-4608
- **Practice address phone:** (765) 807-0592
- **Practice address fax:** (765) 269-7696
- **Mailing address:** 4921 STATE ROAD 26 EAST, SUITE 100, LAFAYETTE, IN 47905-4616
- **Mailing address phone:** (765) 807-0592
- **Mailing address fax:** (765) 269-7696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | 12011052A | IN | — |

## Other

- **Enumeration date:** 04/10/2013
- **Last updated:** 05/11/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200880660 | — | IN |