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 1356772677

Drs Brock, Henderson, Di Prisco, Ravelo and Green Inc is an Oral and Maxillofacial Surgery (Dentist) in Parkersburg, West Virginia. Licensed in West Virginia. Registered with an NPI since 2013.

Licensed in
WV
In the registry since
2013
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

417 Grand Park Dr Ste 103
Parkersburg, WV 26105
Phone: (304) 699-5010
Fax: (304) 553-7268
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

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

Record details

NPI number1356772677
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lesley Coyner — Credentialing · (304) 720-7819
Other names Mt State Oral & Maxillofacial Surge; Mt State Oral & Maxillofacial Surge
NPI enumeratedDecember 12, 2013
Last updated in NPPESMay 30, 2025
Certification dateMay 30, 2025
Mailing address103 Station Place Way, Hurricane, WV 25526-8747

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