MEDICARE: DR. DALTON W PIGMAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	212772	AK

General Provider Information

NPI Number	:	1578051132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALTON W PIGMAN DMD

Provider Business Mailing Address
First Line	:	85 W HORIZON DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-4420
Country	:	US
Telephone Number	:	918-381-0192
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 W CORRAL AVE
Second Line	:
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-7541
Country	:	US
Telephone Number	:	907-260-5439
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2018
Last Update Date	:	01/12/2026

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