Organization · Type 2 NPI

DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc

Oral and Maxillofacial Surgery (Dentist) · Charleston, WV

NPI number 1447711858 Active

Practice location

4307 Maccorkle Ave SE
Charleston, WV 25304-2500

Call (304) 345-1092 Map

Mailing address

103 Station Place Way
Hurricane, WV 25526-8747

Specialties and licenses

Taxonomy	Code	License
Oral and Maxillofacial Surgery (Dentist) Primary	1223S0112X	None listed

Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

3 other providers at this address

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NPI record

NPI: 1447711858
Entity type: Organization (Type 2)
Issued: Mar 28, 2019
Last updated: May 30, 2025
Status: Active

Other names

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MT State Oral & Facial Surgery · doing business as
MT State Oral & Facial Surgery · doing business as

Authorized official

Lesley Marie Coyner
Credentialing
(304) 345-1092

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1447711858

DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc's National Provider Identifier is 1447711858, issued on Mar 28, 2019. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Charleston, WV. The record was last updated on May 30, 2025.