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DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
NPI 1003388117
Dentist - Oral and Maxillofacial Surgery in Ashland, KY

Active since December 31, 2018CLIA Certified · 3 labs
2301 LEXINGTON AVE STE 120, ASHLAND, KY 41101(304) 399-1092 Get Directions Write a Review

NPPES record last updated: May 29, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 29, 2025, Dec 3, 2020, Dec 31, 2018 (3 updates tracked since 2018).

About Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC (NPI 1003388117), doing business as Mt State Oral & Facial Surgery, is a healthcare organization registered as an oral and maxillofacial surgery in Ashland, Kentucky and active in the NPI registry since December 2018. The organization holds 3 active CLIA laboratory certificates and lists Lesley Marie Coyner, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1003388117
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameDRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
Location Address2301 LEXINGTON AVE STE 120Ashland, KY 41101-2807
Mailing Address103 Station Place WayHurricane, WV 25526-8747 · (304) 720-7819
Phone(304) 399-1092
Organization SubpartNo
Authorized OfficialLesley Marie CoynerCredentialing · (304) 345-1092
Enumeration DateDecember 31, 2018
Last NPPES UpdateMay 29, 20253 updates tracked since enumeration
NPPES CertifiedMay 29, 2025
✔ NPI 1003388117 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
2301 LEXINGTON AVE STE 120, Ashland, KY 41101
Open in Google Maps ↗

Other Names 1

Doing Business AsMt State Oral & Facial Surgery

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D2318188

Drs Brock, Henderson, Diprsico, Ravelo & Green · Ashland, KY
Active · expires Feb 5, 2027
CLIA Number18D2318188
Laboratory TypePhysician Office
Certificate Effective DateFebruary 6, 2025
Certificate Expiration DateFebruary 5, 2027
Laboratory DirectorMs. Christy P. Estep
Laboratory Phone(606) 467-2077
Laboratory LocationDrs Brock, Henderson, Diprsico, Ravelo & Green2301 Lexington Ave, Suite 120, Ashland, KY 41101
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 51D2058560

Drs Brock, Henderson, Di Prisco, Ravelo & Green · Charleston, WV
Active · expires May 8, 2027
CLIA Number51D2058560
Laboratory TypeOral & Maxillofacial Surg
Certificate Effective DateMay 9, 2025
Certificate Expiration DateMay 8, 2027
Laboratory DirectorChristy Estep
Laboratory Phone(304) 345-1092
Laboratory LocationDrs Brock, Henderson, Di Prisco, Ravelo & Green869 Oakwood Road, Charleston, WV 25314
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 51D2058562

Drs Brock, Henderson, Di Prisco, Ravelo & Green · Huntington, WV
Active · expires May 8, 2027
CLIA Number51D2058562
Laboratory TypeOral & Maxillofacial Surg
Certificate Effective DateMay 9, 2025
Certificate Expiration DateMay 8, 2027
Laboratory DirectorChristy Estep
Laboratory Phone(304) 399-1092
Laboratory LocationDrs Brock, Henderson, Di Prisco, Ravelo & Green3135 16th Street Road Suite 20, Huntington, WV 25701
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STEVEN WAYNE LEDFORD JR. DDS
Dentist
2301 LEXINGTON AVE STE 120
ASHLAND, KY 41101
Boyd County (304) 399-1092

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc's NPI number?

The NPI number for Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is 1003388117. It was assigned to this organization in the NPPES registry on December 31, 2018. The provider is doing business as Mt State Oral & Facial Surgery.

Where is Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc located?

Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is located at 2301 Lexington Ave Ste 120, Ashland, KY 41101. The listed phone number is (304) 399-1092.

What is Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Does Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc was last updated on May 29, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.