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

Q: 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.

Q: 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.

Q: 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 60 days 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 April 15, 2021PECOS Enrolled

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: August 16, 2026.

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

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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 is enrolled in Medicare PECOS.

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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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. Trystan Richard Wiedow 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 54304 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

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

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 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)