Healthcare Provider Details

I. General information

NPI: 1205713567
Provider Name (Legal Business Name): FREEDOM DENTAL CARE DE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 CONCORD PIKE
WILMINGTON DE
19803-2904
US

IV. Provider business mailing address

2006 LIMESTONE RD STE 5
WILMINGTON DE
19808-5553
US

V. Phone/Fax

Practice location:
  • Phone: 888-707-4942
  • Fax:
Mailing address:
  • Phone: 302-299-5617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KYLE GREEN
Title or Position: OWNER
Credential: DDS
Phone: 302-563-4599