MEDICARE: FREEDOM DENTAL CARE PA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1407738438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM DENTAL CARE PA PLLC

Provider Business Mailing Address
First Line	:	2006 LIMESTONE RD STE 5
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19808-5553
Country	:	US
Telephone Number	:	302-239-1757
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 LONG LN
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-5112
Country	:	US
Telephone Number	:	215-709-0001
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KYLE GREEN
Credential	:	DDS
Telephone Number	:	302-563-4599

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	08/19/2025

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