Provider Demographics
NPI:1033235148
Name:DUST, BELINDA J
Entity Type:Individual
Prefix:MRS
First Name:BELINDA
Middle Name:J
Last Name:DUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2216
Mailing Address - Country:US
Mailing Address - Phone:765-477-0462
Mailing Address - Fax:765-477-0781
Practice Address - Street 1:2441 E STATE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2216
Practice Address - Country:US
Practice Address - Phone:765-477-0462
Practice Address - Fax:765-477-0781
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000222495OtherBREAST AND BRA'S
IN2003875540AMedicaid
IN2003875540AMedicaid