Gallatin Valley Maxillofacial & Aesthetic Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

GALLATIN VALLEY MAXILLOFACIAL & AESTHETIC SURGERY

Practice address

1994 Stadium Dr
Bozeman, MT 59715-0655

Phone

(406) 587-0767

Fax

(406) 587-2120

NPI assigned

Sep 11, 2019

Organization subpart

No

Name

Brian R. Chisdak, MD

Title

Owner

Phone

(406) 587-0767

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 11, 2019.

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568160000000",
    "number": "1992355929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1994 STADIUM DR",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597150655",
            "telephone_number": "406-587-0767",
            "fax_number": "406-587-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1994 STADIUM DR",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597150655",
            "telephone_number": "406-587-0767",
            "fax_number": "406-587-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLATIN VALLEY MAXILLOFACIAL & AESTHETIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-11",
        "last_updated": "2019-09-11",
        "status": "A",
        "authorized_official_last_name": "CHISDAK",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-587-0767",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1689745804",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1457573727",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1336301266",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.brianchisdakmd.com",
            "affiliation": "N",
            "endpointDescription": "secure website",
            "address_1": "1994 Stadium Dr",
            "city": "Bozeman",
            "state": "MT",
            "country_code": "US",
            "postal_code": "597150655",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gallatin Psychotherapy, Inc
• Gallatin Valley Anesthesia Associates
• Gallatin Valley Anesthesia Associates PC
• Gallatin Valley Chiropractic, LLC
• Gallatin Valley Denture Center
• Gallatin Valley Pediatric Dentistry
• Gallatin Valley Surgery Center, LLC
• Gallatin Valley Surgical Arts
• Gallatin Valley Vision, LLC
• Gallatin Valley YMCA

• All providers in Bozeman, MT
• Oral and Maxillofacial Surgery (Dentist) in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.