Provider Demographics
NPI:1174493381
Name:IMBODEN, RACHEL NICOLE (RDH)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:NICOLE
Last Name:IMBODEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:NICOLE
Other - Last Name:PODKONJAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:5752 PALMER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-1511
Mailing Address - Country:US
Mailing Address - Phone:719-445-0827
Mailing Address - Fax:
Practice Address - Street 1:5752 PALMER PARK BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-1511
Practice Address - Country:US
Practice Address - Phone:719-445-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-11
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002025816124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist