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

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

Organization Oral and Maxillofacial Surgery (Dentist) · NPI 1003388117

Drs Brock, Henderson, Di Prisco, Ravelo and Green Inc is an Oral and Maxillofacial Surgery (Dentist) in Ashland, Kentucky. Registered with an NPI since 2018.

In the registry since
2018
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2301 Lexington Ave Ste 120
Ashland, KY 41101-2807
Phone: (304) 399-1092
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X

Record details

NPI number1003388117
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lesley Coyner — Credentialing · (304) 345-1092
Other names Mt State Oral & Facial Surgery; Mt State Oral & Facial Surgery
NPI enumeratedDecember 31, 2018
Last updated in NPPESMay 29, 2025
Certification dateMay 29, 2025
Mailing address103 Station Place Way, Hurricane, WV 25526-8747

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