Provider Demographics
NPI:1245384270
Name:TRAIL, LEO V JR (DDS, MS, PA)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:V
Last Name:TRAIL
Suffix:JR
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COLGATE DR.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050
Mailing Address - Country:US
Mailing Address - Phone:410-836-8567
Mailing Address - Fax:410-836-9677
Practice Address - Street 1:2 COLGATE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2624
Practice Address - Country:US
Practice Address - Phone:410-836-8567
Practice Address - Fax:410-836-9677
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD70771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics