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 1447711858

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 2019.

In the registry since
2019
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

4307 Maccorkle Ave SE
Charleston, WV 25304-2500
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 number1447711858
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 enumeratedMarch 28, 2019
Last updated in NPPESMay 30, 2025
Certification dateMay 30, 2025
Mailing address103 Station Place Way, Hurricane, WV 25526-8747

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