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Organization
DOMINIQUE BULTSMA MD PC
Active
Organization
DOMINIQUE BULTSMA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE BULTSMA MD (OWNER)
(843) 412-9012
Entity
Organization
Contact information
Practice address
2142 EXECUTIVE HALL RD, CHARLESTON, SC 29407-8713
(843) 729-6316
Mailing address
2142 EXECUTIVE HALL RD, CHARLESTON, SC 29407-8713
(843) 729-6316
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
05/27/2025
Last updated
06/26/2026
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