Provider Demographics
NPI:1841172871
Name:FREEDOM DENTAL CARE PA PLLC
Entity type:Organization
Organization Name:FREEDOM DENTAL CARE PA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-563-4599
Mailing Address - Street 1:2006 LIMESTONE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5553
Mailing Address - Country:US
Mailing Address - Phone:302-239-1757
Mailing Address - Fax:
Practice Address - Street 1:2340 S 12TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3540
Practice Address - Country:US
Practice Address - Phone:215-709-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN & ROBINSON DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-22
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty