Healthcare Provider Details

I. General information

NPI: 1851005904
Provider Name (Legal Business Name): ROOTS DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6291 N FOX RUN WAY STE 120
MERIDIAN ID
83646-6791
US

IV. Provider business mailing address

5436 N EXETER WAY
MERIDIAN ID
83646-4691
US

V. Phone/Fax

Practice location:
  • Phone: 208-821-2206
  • Fax:
Mailing address:
  • Phone: 208-821-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM FREI
Title or Position: OWNER/PARTNER
Credential: DMD
Phone: 208-821-2206