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General NPI Number Information
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NPI Number | 1851005904
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Entity Type | Organization
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Legal Business Name | ROOTS DENTAL PLLC
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 6291 N FOX RUN WAY STE 120
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City | MERIDIAN
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State | ID
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Zip | 83646-6791
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Country | US
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Telephone | 208-821-2206
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Fax |
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Provider Business Mailing Address
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Address Line | 5436 N EXETER WAY
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City | MERIDIAN
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State | ID
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Zip | 83646-4691
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Country | US
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Telephone | 208-821-2206
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. WILLIAM FREI
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Credential | DMD
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Telephone | 208-821-2206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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