MEDICARE: CAMERON LUKE ROBERTSON DDS

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	122300000X	Dentist	2025019758	MO

General Provider Information

NPI Number	:	1326932500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON LUKE ROBERTSON DDS

Provider Business Mailing Address
First Line	:	2604 W GOLDFINCH DR
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-0020
Country	:	US
Telephone Number	:	417-299-0324
Fax Number	:	417-299-0324

Provider Business Practice Location Address
First Line	:	18020 BUSINESS 13 STE E
Second Line	:
City	:	BRANSON WEST
State	:	MO
Zip	:	65737-9685
Country	:	US
Telephone Number	:	417-272-3352
Fax Number	:

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

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	06/04/2025

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