John E Brock, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

3308 Issued in WV

Practice address

100A Prestige Park Dr
Hurricane, WV 25526-8417

Phone

(304) 757-0272

Fax

(304) 757-0273

NPI assigned

Aug 12, 2006

Last updated

Sep 26, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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

  dba Mt State Oral & Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Charleston, WV
  • NPI 1447711858
  NPD (past)
• DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Hurricane, WV
  • NPI 1992766737
  NPD (past)
• Alaska Oral & Facial Surgery Center Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Fairbanks, AK
  • NPI 1912919895
  NPD (past)

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1376555227",
    "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": "100A PRESTIGE PARK DR",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255268417",
            "telephone_number": "304-757-0272",
            "fax_number": "304-757-0273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "JOHN",
        "middle_name": "E",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "3308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV DENTAL LIC.",
            "identifier": "3308",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY DENTAL LICENSE",
            "identifier": "10439",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810012787",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECIALIST, ORAL AND MAXILLOFACIAL SURGERY",
            "identifier": "129",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Scott Bowyer, COTA
• Leslie J Boyd, LCSW
• Barbara B Brady
• Gisette Brewster
• Bright Beginnings LLC
• Rebecca Brogan
• Shannon Brooks
• Pamela Sue Brown
• William Matthew Brown
• Alexis Browning

• Oral and Maxillofacial Surgery (Dentist) in Hurricane, WV
• Providers in Hurricane, WV by specialty
• 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 Sep 26, 2022; 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.