Provider Demographics
NPI:1730067513
Name:FREEDOM DENTAL SELECT DE LLC
Entity type:Organization
Organization Name:FREEDOM DENTAL SELECT DE LLC
Other - Org Name:
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 1:58 OMEGA DR # F58
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2062
Practice Address - Country:US
Practice Address - Phone:302-456-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN & ROBINSON DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty