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

895 E Washington Ave
Vinton, VA 24179-2105

Phone

(304) 425-8220

NPI assigned

Mar 1, 2022

Organization subpart

Yes

Parent organization

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

Name

Lesley Marie Coyner

Title

Credentialing

Phone

(304) 720-7819

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

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

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

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

Tax ID family

DRS Krajekian Brock Henderson Inc (3 organizations share this tax ID)

Part of

DRS Krajekian Brock Henderson Inc

• Mt State Oral & Facial Surgery Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 30, 2025.

{
    "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

• All providers in Vinton, VA
• 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.