Healthcare Provider Details

I. General information

NPI: 1447819784
Provider Name (Legal Business Name): OLGA A SANIUKOVICH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 45TH ST S STE 108
FARGO ND
58103-3247
US

IV. Provider business mailing address

3626 E HAMILTON KY
WEST PALM BEACH FL
33411-6436
US

V. Phone/Fax

Practice location:
  • Phone: 701-526-4652
  • Fax: 701-282-2572
Mailing address:
  • Phone: 727-505-3720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number12014626A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN24170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: