DR. DAVID WILLIAM WISTROM DDS
NPI 1083632368
Dentist - General Practice in Santa Cruz, CA

Q: What is David Wistrom's NPI number?

The NPI number for David Wistrom is 1083632368. It was assigned to this individual provider in the NPPES registry on July 17, 2006.

Q: What is David Wistrom's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for David Wistrom was last updated on August 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 17, 2006PECOS Enrolled

1830 COMMERCIAL WAY, SANTA CRUZ, CA 95065(831) 464-5409(831) 464-5415 Get Directions Write a Review

NPPES record last updated: August 25, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Dr. David William Wistrom Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DAVID WILLIAM WISTROM DDS (NPI 1083632368) is an individual general practice provider in Santa Cruz, California, licensed in California (42785) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS and maintains a secondary practice location in Watsonville.

NPPES Registry Identity

NPI1083632368

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. DAVID WILLIAM WISTROMCredential: DDS

Location Address1830 COMMERCIAL WAYSanta Cruz, CA 95065-1819

Mailing Address1830 Commercial WaySanta Cruz, CA 95065-1819 · (831) 464-5409 · Fax (831) 464-5415

Phone(831) 464-5409

Fax(831) 464-5415

Sole ProprietorNo

Enumeration DateJuly 17, 2006

Last NPPES UpdateAugust 25, 2025

NPPES CertifiedAugust 25, 2025

✔ NPI 1083632368 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in CA · 42785

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

1830 COMMERCIAL WAY, Santa Cruz, CA 95065

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Secondary Practice Location 1

Location 155 Penny Ln Ste 103Watsonville, CA 95076-6017 · Phone (831) 218-5341 · Fax (831) 218-5611

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. David William Wistrom Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95065 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$96.03 typical visit price

range $62.97 – $186.69

Typical copayment $24.00 (range $15.74 – $46.67)

Most-billed visit code 99203

Established Patient

$77.84 typical visit price

range $21.02 – $153.16

Typical copayment $19.46 (range $5.25 – $38.29)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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