MEDICARE: MRS. RACHEL NICOLE IMBODEN RDH

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	124Q00000X	Dental Hygienist	002025816	CO

General Provider Information

NPI Number	:	1174493381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL NICOLE IMBODEN RDH

Provider Business Mailing Address
First Line	:	5752 PALMER PARK BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-1511
Country	:	US
Telephone Number	:	719-445-0827
Fax Number	:

Provider Business Practice Location Address
First Line	:	5752 PALMER PARK BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-1511
Country	:	US
Telephone Number	:	719-445-0827
Fax Number	:

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

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	11/19/2025

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