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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: October 18, 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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

12

Medicare enrollment records show 12 clinicians reassign Medicare billing to Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (12)

Jose Ravelo, DDS
Oral Surgery
NPI 1457693020
869 OAKWOOD RD
Charleston, WV 25314
(304) 345-1092
✔ PECOS53 mi
James Henderson, M.D./DDS
Oral Surgery
NPI 1295799963
415 MORRIS ST SUITE 309
Charleston, WV 25301
(304) 388-3290
✔ PECOS55 mi
Kenny Nguyen, DDS
Oral Surgery
NPI 1528637378
4307 MACCORKLE AVE SE
Charleston, WV 25304
(304) 720-7819
✔ PECOS✔ Accepts Medicare58 mi
Brandi Lantz, DDS
Oral Surgery
NPI 1538804828
417 GRAND PARK DR STE 103
Parkersburg, WV 26105
(304) 699-5010
✔ PECOS✔ Accepts Medicare82 mi
Timothy Bartholomew, DDS
Oral Surgery
NPI 1306077656
630 LEXINGTON AVE
Mansfield, OH 44907
(419) 756-0711
✔ PECOS157 mi
John Green, DDS FACS
Oral Surgery
NPI 1770892705
895 E WASHINGTON AVE
Vinton, VA 24179
(540) 344-7252
✔ PECOS171 mi
Peter Dorf, DMD
Oral Surgery
NPI 1174178263
9225 DOERR RD
Ft Belvoir, VA 22060
(922) 512-2022
✔ PECOS296 mi
John Mclaughlin, DDS
Oral Surgery
NPI 1649200783
14346 WARWICK BLVD
Newport News, VA 23602
(757) 755-8771
✔ PECOS✔ Accepts Medicare346 mi
Ryane Staples, DMD
Oral Surgery
NPI 1750906814
NAVAL MEDICAL CENTER PORTSMOUTH 620 JOHN PAUL JONES CIRCLE
Portsmouth, VA 23708
(757) 953-2711
✔ PECOS364 mi
Kyle Lee, DDS
Oral Surgery
NPI 1306299565
620 JOHN PAUL JONES CIR
Portsmouth, VA 23708
(757) 953-2730
✔ PECOS✔ Accepts Medicare365 mi
Enrique Schubert, DDS
Oral Surgery
NPI 1447791454
1611 NW 12TH AVE
Miami, FL 33136
(305) 585-5326
✔ PECOS885 mi
Italo Di Prisco, D.D.S
Oral Surgery
NPI 1871807875
51SW 11TH ST. APT 1034
Miami, FL 33130
(786) 219-6497
✔ PECOS887 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

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.

Is Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc enrolled in Medicare?

Yes. Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 12 clinicians, all in Oral Surgery, reassign their Medicare billing to Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.