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DR. TRYSTAN RICHARD WIEDOW DDS
NPI 1427639038
Dentist - Oral and Maxillofacial Surgery in Green Bay, WI

Active since April 15, 2021Opted out of Medicare · through Jul 8, 2028
2353 S RIDGE RD, GREEN BAY, WI 54304(920) 499-0471 Get Directions Write a Review

NPPES record last updated: June 20, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 24, 2022, Sep 20, 2021, Jun 21, 2021 and 1 more (4 updates tracked since 2021).

About Dr. Trystan Richard Wiedow Dds NPPES

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

DR. TRYSTAN RICHARD WIEDOW DDS (NPI 1427639038) is an individual oral and maxillofacial surgery provider in Green Bay, Wisconsin, licensed in Wisconsin (1002773-15) and active in the NPI registry since April 2021. He has opted out of Medicare through July 8, 2028.

NPPES Registry Identity

NPI1427639038
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameDR. TRYSTAN RICHARD WIEDOWCredential: DDS
Location Address2353 S RIDGE RDGreen Bay, WI 54304-5857
Mailing Address2353 S Ridge Rd Ste 1Green Bay, WI 54304-5069
Phone(920) 499-0471
Sole ProprietorNo
Enumeration DateApril 15, 2021
Last NPPES UpdateJune 20, 20264 updates tracked since enumeration
NPPES CertifiedJune 20, 2026
✔ NPI 1427639038 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in WI · 1002773-15
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License 1002773 (WI), RES-30614 (IA)
2353 S RIDGE RD, Green Bay, WI 54304
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Dean Health Plan, Delta Dental of Wisconsin, Inc., Humana.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Trystan Richard Wiedow Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 8, 2026 through July 8, 2028.

Opt-Out Effective DateJuly 8, 2026
Opt-Out In Effect ThroughJuly 8, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 7

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

DR. BRADLEY S KOCH D.D.S.
Dentist (Oral and Maxillofacial Surgery)
2353 S RIDGE RD
GREEN BAY, WI 54304
Brown County (920) 499-0471
DR. TIMOTHY JASON LEMOINE DDS
Dentist (Oral and Maxillofacial Surgery)
2353 S RIDGE RD
GREEN BAY, WI 54304
Brown County (920) 499-0471
ARDIT HAXHIA DDS
Dentist (Oral and Maxillofacial Surgery)
2353 S RIDGE RD
GREEN BAY, WI 54304
Brown County (920) 499-0471
DR. DAVID L LEMOINE D.D.S.
Dentist (Oral and Maxillofacial Surgery)
2353 S RIDGE RD
GREEN BAY, WI 54304
Brown County (920) 499-0471
DR. VIJAY S PARMAR D.D.S.
Dentist (Oral and Maxillofacial Surgery)
2353 S RIDGE RD
GREEN BAY, WI 54304
Brown County (920) 499-0471
DR. MICHAEL M MISKELLA D.D.S.
Dentist (Oral and Maxillofacial Surgery)
2353 S RIDGE RD
GREEN BAY, WI 54304
Brown County (920) 499-0471
DR. ANDREW R LULLOFF D.D.S.
Dentist (Endodontics)
2353 S RIDGE RD
GREEN BAY, WI 54304
Brown County (920) 499-0471

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Trystan Wiedow's NPI number?

The NPI number for Trystan Wiedow is 1427639038. It was assigned to this individual provider in the NPPES registry on April 15, 2021.

Where is Trystan Wiedow located?

Trystan Wiedow practices at 2353 S Ridge Rd, Green Bay, WI 54304. The listed phone number is (920) 499-0471.

What is Trystan Wiedow's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Trystan Wiedow enrolled in Medicare?

No. Trystan Wiedow has opted out of Medicare through July 8, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Trystan Wiedow accept?

Health plans from Dean Health Plan, Delta Dental of Wisconsin, Inc. and Humana list Trystan Wiedow as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Trystan Wiedow was last updated on June 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.