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General NPI Number Information
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NPI Number | 1659243731
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Entity Type | Organization
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Legal Business Name | FREEDOM DENTAL SELECT DE LLC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 2304 CONCORD PIKE
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City | WILMINGTON
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State | DE
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Zip | 19803-2912
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Country | US
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Telephone | 302-469-4699
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Fax |
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Provider Business Mailing Address
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Address Line | 2006 LIMESTONE RD STE 5
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City | WILMINGTON
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State | DE
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Zip | 19808-5553
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Country | US
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Telephone | 302-299-5617
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLE GREEN
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Credential |
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Telephone | 302-563-4599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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