Organization
GALLATIN VALLEY MAXILLOFACIAL & AESTHETIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN R. CHISDAK MD (OWNER)
(406) 587-0767
Entity
Organization
Contact information
Practice address
1994 STADIUM DR, BOZEMAN, MT 59715-0655
(406) 587-0767
(406) 587-2120
Mailing address
1994 STADIUM DR, BOZEMAN, MT 59715-0655
(406) 587-0767
(406) 587-2120
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336301266
NPI
—
01
—
1457573727
NPI
MT
01
—
1689745804
NPI
—
Enumeration date
09/11/2019
Last updated
09/11/2019
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