Kyle David Green, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

G-1344 Issued in DE

Practice address

4901 Limestone Rd
Wilmington, DE 19808-1271

Phone

(302) 239-0410

NPI assigned

Apr 30, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Freedom Dental Care de LLC

  dba Pike Creek Dental

  • General Practice Dentistry
  • Wilmington, DE
  • NPI 1124905427
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1093150492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 W 14TH ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "19899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 LIMESTONE RD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198081271",
            "telephone_number": "302-239-0410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KYLE",
        "middle_name": "DAVID",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-30",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DE",
            "license": "G-1344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Green
• Jason Robert Green, M.S.P.T.
• Kathleen Teresa Green, LPN
• Kelly Ann Green, F.N.P.
• Kristen Elizabeth Green, MS, BCBA, LBS
• Latonyia Anise Green
• Nicole A Green, MD
• Sharif Green
• Manon Therese Greenberg, M.S., CCC-SLP
• Rebecca Ann Greenberg, M.D.

• General Practice Dentistry in Wilmington, DE
• Providers in Wilmington, DE by specialty
• General Practice Dentistry in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.