Organization
SHANE T COPE LLC
Active
Other names
Highland Creek Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE T COPE DDS (OWNER)
(765) 807-0592
Entity
Organization
Contact information
Practice address
4921 STATE ROAD 26 E, SUITE 100, LAFAYETTE, IN 47905-4608
(765) 807-0592
(765) 269-7696
Mailing address
4921 STATE ROAD 26 EAST, SUITE 100, LAFAYETTE, IN 47905-4616
(765) 807-0592
(765) 269-7696
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
12011052A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200880660
—
IN
Enumeration date
04/10/2013
Last updated
05/11/2023
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