1. Home
  2. Directory
  3. West Virginia
  4. Parkersburg
  5. Dentist
  6. NPI Profile

DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
NPI 1356772677
Dentist - Oral and Maxillofacial Surgery in Parkersburg, WV

Active since December 12, 2013CLIA 51D2088632 · Waiver
417 GRAND PARK DR, SUITE 103, PARKERSBURG, WV 26105(304) 699-5010(304) 553-7268 Get Directions Write a Review

NPPES record last updated: May 30, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 30, 2025, Dec 3, 2020, Jun 15, 2018 and 1 more (4 updates tracked since 2016).

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 1356772677), doing business as Mt State Oral & Maxillofacial Surge, is a healthcare organization registered as an oral and maxillofacial surgery in Parkersburg, West Virginia and active in the NPI registry since December 2013. The organization holds a CLIA Waiver certificate valid through December 15, 2026 and lists Lesley Marie Coyner, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1356772677
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameDRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
Location Address417 GRAND PARK DR, SUITE 103Parkersburg, WV 26105
Mailing Address103 Station Place WayHurricane, WV 25526-8747 · (304) 720-7819 · Fax (304) 345-5080
Phone(304) 699-5010
Fax(304) 553-7268
Organization SubpartNo
Authorized OfficialLesley Marie CoynerCredentialing · (304) 720-7819
Enumeration DateDecember 12, 2013
Last NPPES UpdateMay 30, 20254 updates tracked since enumeration
NPPES CertifiedMay 30, 2025
✔ NPI 1356772677 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.
417 GRAND PARK DR, Parkersburg, WV 26105
Open in Google Maps ↗

Other Names 1

Doing Business AsMt State Oral & Maxillofacial Surge

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Highmark Blue Cross Blue Shield West Virginia.Insurance ›

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. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (12)

Brandi Lantz, DDS
Oral Surgery
NPI 1538804828
417 GRAND PARK DR STE 103
Parkersburg, WV 26105
(304) 699-5010
✔ PECOS✔ Accepts MedicareSame address
James Henderson, M.D./DDS
Oral Surgery
NPI 1295799963
415 MORRIS ST SUITE 309
Charleston, WV 25301
(304) 388-3290
✔ PECOS66 mi
Jose Ravelo, DDS
Oral Surgery
NPI 1457693020
869 OAKWOOD RD
Charleston, WV 25314
(304) 345-1092
✔ PECOS66 mi
Kenny Nguyen, DDS
Oral Surgery
NPI 1528637378
4307 MACCORKLE AVE SE
Charleston, WV 25304
(304) 720-7819
✔ PECOS✔ Accepts Medicare67 mi
Timothy Bartholomew, DDS
Oral Surgery
NPI 1306077656
630 LEXINGTON AVE
Mansfield, OH 44907
(419) 756-0711
✔ PECOS112 mi
John Green, DDS FACS
Oral Surgery
NPI 1770892705
895 E WASHINGTON AVE
Vinton, VA 24179
(540) 344-7252
✔ PECOS166 mi
Peter Dorf, DMD
Oral Surgery
NPI 1174178263
9225 DOERR RD
Ft Belvoir, VA 22060
(922) 512-2022
✔ PECOS239 mi
John Mclaughlin, DDS
Oral Surgery
NPI 1649200783
14346 WARWICK BLVD
Newport News, VA 23602
(757) 755-8771
✔ PECOS✔ Accepts Medicare311 mi
Ryane Staples, DMD
Oral Surgery
NPI 1750906814
NAVAL MEDICAL CENTER PORTSMOUTH 620 JOHN PAUL JONES CIRCLE
Portsmouth, VA 23708
(757) 953-2711
✔ PECOS332 mi
Kyle Lee, DDS
Oral Surgery
NPI 1306299565
620 JOHN PAUL JONES CIR
Portsmouth, VA 23708
(757) 953-2730
✔ PECOS✔ Accepts Medicare332 mi
Enrique Schubert, DDS
Oral Surgery
NPI 1447791454
1611 NW 12TH AVE
Miami, FL 33136
(305) 585-5326
✔ PECOS934 mi
Italo Di Prisco, D.D.S
Oral Surgery
NPI 1871807875
51SW 11TH ST. APT 1034
Miami, FL 33130
(786) 219-6497
✔ PECOS936 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

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 51D2088632

Drs Brock, Henderson, Di Prisco, Ravelo & Green · Parkersburg, WV
Active · expires Dec 15, 2026
CLIA Number51D2088632
Laboratory TypeOral & Maxillofacial Surg
Certificate Effective DateDecember 16, 2024
Certificate Expiration DateDecember 15, 2026
Laboratory DirectorChristy Estep
Laboratory Phone(304) 699-5010
Laboratory LocationDrs Brock, Henderson, Di Prisco, Ravelo & Green417 Grand Park Drive Suite 103, Parkersburg, WV 26105
CLIA data matches this NPI record on: Address 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 1356772677. It was assigned to this organization in the NPPES registry on December 12, 2013. The provider is doing business as Mt State Oral & Maxillofacial Surge.

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

Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is located at 417 Grand Park Dr Suite 103, Parkersburg, WV 26105. The listed phone number is (304) 699-5010.

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. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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

Yes. A Certificate of Waiver (number 51D2088632) is associated with this NPI, valid through December 15, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc accept?

Health plans from Highmark Blue Cross Blue Shield West Virginia list Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

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 30, 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.