Individual
DR. RIZA THAIBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1113 PROGRESS DR, MEDFORD, OR 97504-5201
(541) 512-3900
Mailing address
931 CHEVY WAY, MEDFORD, OR 97504-4127
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11487
OR
122300000X
Dentist
D14063
MN
Other
Enumeration date
06/28/2018
Last updated
08/23/2023
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