Provider Demographics
NPI:1134799638
Name:ROBERTSON, CHANDLER L (DDS)
Entity type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6012
Mailing Address - Country:US
Mailing Address - Phone:417-844-0706
Mailing Address - Fax:
Practice Address - Street 1:1652 N BUSINESS RTE 5
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6502
Practice Address - Country:US
Practice Address - Phone:573-346-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021019492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist