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 1073211637

Drs Brock, Henderson, Di Prisco, Ravelo and Green Inc is an Oral and Maxillofacial Surgery (Dentist) in Charleston, West Virginia. Registered with an NPI since 2023.

In the registry since
2023
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

869 Oakwood Rd
Charleston, WV 25314-2057
Phone: (304) 345-1092
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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 number1073211637
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lesley Coyner — Accts Receivable Manager · (304) 720-7819
Other names Mt State Oral & Facial Surgery; Mt State Oral & Facial Surgery
NPI enumeratedFebruary 22, 2023
Last updated in NPPESMay 29, 2025
Certification dateMay 29, 2025
Mailing address103 Station Place Way, Hurricane, WV 25526-8747

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