# GALLATIN VALLEY MAXILLOFACIAL & AESTHETIC SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992355929
- **Authorized official:** BRIAN R. CHISDAK MD (OWNER)
- **Authorized official phone:** (406) 587-0767

## Contact information

- **Practice address:** 1994 STADIUM DR, BOZEMAN, MT 59715-0655
- **Practice address phone:** (406) 587-0767
- **Practice address fax:** (406) 587-2120
- **Mailing address:** 1994 STADIUM DR, BOZEMAN, MT 59715-0655
- **Mailing address phone:** (406) 587-0767
- **Mailing address fax:** (406) 587-2120

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2019
- **Last updated:** 09/11/2019