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NPI Code Detail

MEDICARE: DR. LEAH MAMMEN DMD

MEDICARE: DR. LEAH MAMMEN DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD-00221KY

General Provider Information

NPI Number : 1598600298
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEAH MAMMEN DMD
Provider Business Mailing Address
First Line : 12711 WILLOW PARK DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-4692
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12711 WILLOW PARK DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-4692
Country : US
Telephone Number : 502-930-0017
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2026
Last Update Date : 06/29/2026

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