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

Doing business as

Mt State Oral & Facial Surgery

Practice address

895 E Washington Ave
Vinton, VA 24179-2105

Phone

(304) 425-8220

NPI assigned

Mar 1, 2022

Last updated

May 30, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

DRS KRAJEKIAN,BROCK,HENDERSON & DIPRISCO INCAs reported in NPPES

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 names 1

• Mt State Oral & Facial Surgery Doing business as

Electronic endpoints 1

Tax ID family

Mountain State Oral Sur3 organizations share this tax ID, including this one

Part of

Mountain State Oral Sur

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

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

  dba Mt State Oral & Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Ashland, KY
  • NPI 1003388117
  NPD tax ID
• DRS Brock, Henderson, Di Prisco, Ravelo and Green Inc

  dba Mt State Oral & Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Charleston, WV
  • NPI 1073211637
  NPD tax ID

Interoperability endpoints

• Direct secure messaging: info@mtstateoms.com

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

{
    "created_epoch": "1646092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1720734684",
    "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": "895 E WASHINGTON AVE",
            "city": "VINTON",
            "state": "VA",
            "postal_code": "241792105",
            "telephone_number": "304-425-8220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DRS KRAJEKIAN,BROCK,HENDERSON & DIPRISCO INC",
        "enumeration_date": "2022-03-01",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "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": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@mtstateoms.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "895 E Washington Ave",
            "city": "Vinton",
            "state": "VA",
            "country_code": "US",
            "postal_code": "241792105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mt State Oral & Facial Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mt State Oral & Facial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Gabriel Digiovanni Jr.
• Denise Dillingham, PA-C
• Jake E Divers IV, PT, DPT
• Alison Danielle Dowdy, PRS
• Downhome Pharmacy-Vinton
• DRS Green & Henderson Inc
• Allyse Renae Dunlop, MA, LPC
• Richard Kindley Dunn, MD
• Nicole Q Dye, SLP
• Dynamic Medical LLC

• Oral and Maxillofacial Surgery (Dentist) in Vinton, VA
• Providers in Vinton, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 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.