Healthcare Provider Details

I. General information

NPI: 1174461057
Provider Name (Legal Business Name): FEDERAL HILL DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 LIGHT ST STE 1
BALTIMORE MD
21230-4783
US

IV. Provider business mailing address

835 LIGHT ST STE 1
BALTIMORE MD
21230-4783
US

V. Phone/Fax

Practice location:
  • Phone: 410-727-3388
  • Fax:
Mailing address:
  • Phone: 410-727-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTAL ELLIS
Title or Position: MANAGING DENTIST
Credential: DDS
Phone: 202-394-3677