GALLATIN VALLEY MAXILLOFACIAL & AESTHETIC SURGERY NPI 1992355929

NPI Information

GALLATIN VALLEY MAXILLOFACIAL & AESTHETIC SURGERY is an oral and maxillofacial surgery dentist in Bozeman, MT. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. GALLATIN VALLEY MAXILLOFACIAL & AESTHETIC SURGERY NPI is 1992355929. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1994 STADIUM DR
BOZEMAN, MT
ZIP 59715-655
Phone: (406) 587-0767
Fax: (406) 587-2120

The provider's authorized official is Brian R. Chisdak .
The authorized official title is Owner and has the following contact phone number (406) 587-0767.

The CLIA number assigned to this NPI record is 27D2181450 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/11/2019 and was last updated on 9/11/2019.

Taxonomy Codes

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