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General NPI Number Information
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NPI Number | 1588997183
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Entity Type | Organization
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Legal Business Name | SHANE T COPE DDS, PC
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 10435 COMMERCE DRIVE SUITE 120
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City | CARMEL
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State | IN
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Zip | 46032
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Country | US
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Telephone | 317-564-4820
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Fax | 317-564-4822
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Provider Business Mailing Address
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Address Line | 10435 COMMERCE DRIVE SUITE 120
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City | CARMEL
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State | IN
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Zip | 46032
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Country | US
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Telephone | 317-564-4820
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Fax | 317-564-4822
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHANE COPE
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Credential | D.D.S., M.S.D.
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Telephone | 317-564-4820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12011052A
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License Number State | IN
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