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

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC

Practice address

1215 Virginia St E
Charleston, WV 25301

Phone

(304) 345-1092

Fax

(304) 345-5080

NPI assigned

Mar 31, 2006

Organization subpart

No

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) 720-7819

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mt State Oral & Maxillofacial Surgeons Doing business as

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1346201183",
    "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",
            "fax_number": "304-345-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 VIRGINIA ST E",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "25301",
            "telephone_number": "304-345-1092",
            "fax_number": "304-345-5080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "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": "304-720-7819"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4500012000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MT. STATE BCBS",
            "identifier": "000817140",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt State Oral & Maxillofacial Surgeons",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mt State Oral & Maxillofacial Surgeons",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kara Dravenstott, FNP-BC
• Lora Drenner
• Donna A Driggs, LPN
• Kevin A Driver, M.D.
• DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc
• DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc
• DRS Whittington & Whittington PTR
• DRS Wilson and Martino of Charleston, PLLC
• DRS. Henry, Kinder & Associates, PLLC
• DRS. Moore and Moore Dental Associates

• All providers in Charleston, WV
• Oral and Maxillofacial Surgery (Dentist) in West Virginia

• 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.