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 2 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 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: November 01, 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

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

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.

Medicare Billing Reassignment

Medicare enrollment records show Maxwell Dismuke reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Redwoods Rural Health Center Inc.

1.0 mi

Community Health

101 WEST COAST ROAD
Redway, CA 95560

Reassigned Medicare billing, California enrollment
16 clinicians in this Medicare group

NPI 1235206087 (707) 923-2783

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

Which organization bills Medicare for Maxwell Dismuke's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Maxwell Dismuke reassigns Medicare benefits to Redwoods Rural Health Center Inc. (Redway, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Maxwell Dismuke's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Maxwell Dismuke accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Humana list Maxwell Dismuke 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 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 2 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.