Healthcare Provider Details

I. General information

NPI: 1801715198
Provider Name (Legal Business Name): BLAKE DUKE BEDDES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DUKE BEDDES DDS

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W 9TH ST STE 2
CASPER WY
82601-3780
US

IV. Provider business mailing address

211 W 9TH ST STE 2
CASPER WY
82601-3780
US

V. Phone/Fax

Practice location:
  • Phone: 307-266-4193
  • Fax:
Mailing address:
  • Phone: 307-266-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1732
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: