OrganizationActive
Drs Brock, Henderson, Di Prisco, Ravelo and Green Inc
NPI 1447711858 · Oral and Maxillofacial Surgery (Dentist) · Charleston, WV
Provider details
- NPI number
- 1447711858
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Organization subpart
- No
- Authorized official
- Lesley Coyner, Credentialing(304) 345-1092
Specialties & taxonomies
Dental Providers
Practice location
4307 Maccorkle Ave Se
Charleston, WV 25304-2500
Phone: (304) 345-1092
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 & Facial Surgery
- Doing business as
- Mt State Oral & Facial Surgery
Registry dates
- Enumerated
- 2019-03-28
- 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.