OrganizationActive
Drs Brock, Henderson, Di Prisco, Ravelo and Green Inc
NPI 1356772677 · Oral and Maxillofacial Surgery (Dentist) · Parkersburg, WV
Provider details
- NPI number
- 1356772677
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Organization subpart
- No
- Authorized official
- Lesley Coyner, Credentialing(304) 720-7819
Specialties & taxonomies
Dental Providers
Practice location
417 Grand Park Dr
Suite 103
Parkersburg, WV 26105
Phone: (304) 699-5010
Fax: (304) 553-7268
Approximate (ZIP-level) locationGet directions
Mailing address
103 Station Place Way
Hurricane, WV 25526-8747
Other names (DBA / former)
- Doing business as
- Mt State Oral & Maxillofacial Surge
- Doing business as
- Mt State Oral & Maxillofacial Surge
Registry dates
- Enumerated
- 2013-12-12
- Last updated
- 2025-05-30
- Certified
- 2025-05-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.