Provider Demographics
NPI:1952877557
Name:VIOLA, LEAH M (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:M
Last Name:VIOLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LEAH
Other - Middle Name:MICHELLE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6700 SOUTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2822
Mailing Address - Country:US
Mailing Address - Phone:502-368-9540
Mailing Address - Fax:
Practice Address - Street 1:6700 SOUTHSIDE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2822
Practice Address - Country:US
Practice Address - Phone:502-368-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013069A122300000X, 1223G0001X
KY102241223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100610480Medicaid