Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MAXWELL THEODORE DISMUKE DDS
NPI 1235098005
Dentist in Redway, CA

Q: What is Maxwell Dismuke's NPI number?

The NPI number for Maxwell Dismuke is 1235098005. It was assigned to this individual provider in the NPPES registry on January 19, 2026.

Q: What is Maxwell Dismuke's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Maxwell Dismuke was last updated on September 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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 January 19, 2026PECOS Enrolled

217 BRICELAND THORN RD, REDWAY, CA 95560(707) 923-2783 Get Directions Write a Review

NPPES record last updated: September 3, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Sep 3, 2026, Apr 21, 2026, Jan 19, 2026 (3 updates tracked since 2026).

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About Maxwell Theodore Dismuke Dds NPPES

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

MAXWELL THEODORE DISMUKE DDS (NPI 1235098005) is an individual dentist in Redway, California, licensed in California (112497) and active in the NPI registry since January 2026. He is enrolled in Medicare PECOS, maintains a secondary practice location in Redway, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1235098005

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameMAXWELL THEODORE DISMUKECredential: DDS

Location Address217 BRICELAND THORN RDRedway, CA 95560

Mailing AddressPo Box 769Redway, CA 95560-0769 · (707) 923-2783

Phone(707) 923-2783

Sole ProprietorYes

Medical School CMSOtherGraduated 2025

Enumeration DateJanuary 19, 2026

Last NPPES UpdateSeptember 3, 20263 updates tracked since enumeration

NPPES CertifiedSeptember 3, 2026

✔ NPI 1235098005 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in CA · 112497

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

217 BRICELAND THORN RD, Redway, CA 95560

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Secondary Practice Location 1

Location 1101 West Coast RdRedway, CA 95560 · Phone (707) 923-2783

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Maxwell Theodore Dismuke Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7517435142

PECOS Enrollment IDI20260501002118

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 95560 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

$90.32 typical visit price

range $58.87 – $176.60

Typical copayment $22.58 (range $14.71 – $44.15)

Most-billed visit code 99203

Established Patient

$73.16 typical visit price

range $19.28 – $144.60

Typical copayment $18.29 (range $4.82 – $36.15)

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.

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 Maxwell Dismuke's NPI number?

The NPI number for Maxwell Dismuke is 1235098005. It was assigned to this individual provider in the NPPES registry on January 19, 2026.

Where is Maxwell Dismuke located?

Maxwell Dismuke practices at 217 Briceland Thorn Rd, Redway, CA 95560. The listed phone number is (707) 923-2783.

What is Maxwell Dismuke's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Maxwell Dismuke enrolled in Medicare?

Yes. Maxwell Dismuke is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Maxwell Dismuke was last updated on September 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.