Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Maxwell Theodore Dismuke, DDS

Individual provider Dentist · NPI 1235098005

Maxwell Theodore Dismuke, DDS is a Dentist in Redway, California. Qualified in 2025, 1 year ago. Practices as a sole proprietor and works from 2 locations. Licensed in California.

Years since qualifying
1
Licensed in
CA
In the registry since
2026
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

See every abbreviation used in this directory →

Practice location Address checks out

101 W Coast Rd
Redway, CA 95560
Phone: (707) 923-2783
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 217 Briceland Thorn Rd, Redway, CA 95560 — (707) 923-2783

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 112497 (CA)

Record details

NPI number1235098005
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorYes
NPI enumeratedJanuary 19, 2026
Last updated in NPPESApril 21, 2026
Certification dateApril 21, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDENTIST
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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