NPIMap

Organization Active NPI

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

  • Oral and Maxillofacial Surgery (Dentist)
  • Beckley, WV
National Provider Identifier
1194364398
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
Practice address
433 Carriage Dr
Beckley, WV 25801-2805
Phone
(304) 256-3777
NPI assigned
Jan 6, 2020
Last updated
May 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lesley Marie Coyner
Title
Credentialing
Phone
(304) 345-1092

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

433 Carriage Dr
Beckley, WV 25801-2805

Mailing address

103 Station Place Way
Hurricane, WV 25526-8747
Phone (304) 720-7819

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Hurricane

National Provider Directory

National Provider Directory

Locations

150 Brookshire Ln
Beckley, WV 25801
Phone (304) 255-1411

1215 Virginia St E
Charleston, WV 25301
Phone (304) 345-1092

3135 16th Street Rd
Ste 20
Huntington, WV 25701
Phone (304) 399-1092

100A Prestige Park Dr
Hurricane, WV 25526
Phone (304) 757-0272

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1194364398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 STATION PLACE WAY",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255268747",
            "telephone_number": "304-720-7819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 CARRIAGE DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258012805",
            "telephone_number": "304-256-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-06",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "COYNER",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-345-1092"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Hurricane",
            "affiliation": "N",
            "endpointDescription": "mailing address",
            "address_1": "433 Carriage Dr",
            "city": "Beckley",
            "state": "WV",
            "country_code": "US",
            "postal_code": "258012805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Beckley, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.