Healthcare Provider Details

I. General information

NPI: 1316633977
Provider Name (Legal Business Name): JOSEPHINE LEONHARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSEPHINE KIM DMD

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 ASHLEY ST
BOWLING GREEN KY
42103-3406
US

IV. Provider business mailing address

3360 HIKES LN
LOUISVILLE KY
40220-2071
US

V. Phone/Fax

Practice location:
  • Phone: 270-842-0025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11187
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: