Individual
DOMINIQUE SAMARANE BULTSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
345 FRESHFIELDS DR STE J101, JOHNS ISLAND, SC 29455-5443
(843) 768-4800
(843) 606-8039
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(888) 472-0043
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
90584
SC
207R00000X
Internal Medicine Physician
LL84222
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
905846
—
SC
Enumeration date
05/29/2020
Last updated
02/23/2026
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