Provider Demographics
NPI:1265040877
Name:K MICHELLE IMBODEN, DDS,PC
Entity Type:Organization
Organization Name:K MICHELLE IMBODEN, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:IMBODEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-633-4591
Mailing Address - Street 1:326 N ROSSER ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-3247
Mailing Address - Country:US
Mailing Address - Phone:870-633-4591
Mailing Address - Fax:870-633-8460
Practice Address - Street 1:326 N ROSSER ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3247
Practice Address - Country:US
Practice Address - Phone:870-633-4591
Practice Address - Fax:870-633-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental