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DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
NPI 1447711858
Dentist - Oral and Maxillofacial Surgery in Charleston, WV

Active since March 28, 2019CLIA 51D2169104 · Waiver
4307 MACCORKLE AVE SE, CHARLESTON, WV 25304(304) 345-1092 Get Directions Write a Review

NPPES record last updated: May 30, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 30, 2025, Dec 3, 2020 (2 updates tracked since 2020).

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 1447711858), doing business as Mt State Oral & Facial Surgery, is a healthcare organization registered as an oral and maxillofacial surgery in Charleston, West Virginia and active in the NPI registry since March 2019. The organization holds a CLIA Waiver certificate valid through July 15, 2027 and lists Lesley Marie Coyner, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1447711858
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameDRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
Location Address4307 MACCORKLE AVE SECharleston, WV 25304-2500
Mailing Address103 Station Place WayHurricane, WV 25526-8747 · (304) 720-7819
Phone(304) 345-1092
Organization SubpartNo
Authorized OfficialLesley Marie CoynerCredentialing · (304) 345-1092
Enumeration DateMarch 28, 2019
Last NPPES UpdateMay 30, 20252 updates tracked since enumeration
NPPES CertifiedMay 30, 2025
✔ NPI 1447711858 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.
4307 MACCORKLE AVE SE, Charleston, WV 25304
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

Accepted Insurance

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

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 51D2169104

Drs Brock Henderson, Diprisco, Ravelo & Green · Charleston, WV
Active · expires Jul 15, 2027
CLIA Number51D2169104
Laboratory TypeOral & Maxillo Facial Sur
Certificate Effective DateJuly 16, 2025
Certificate Expiration DateJuly 15, 2027
Laboratory DirectorChristy Estep
Laboratory Phone(304) 760-6221
Laboratory LocationDrs Brock Henderson, Diprisco, Ravelo & Green4307 Maccorkle Ave SE, Charleston, WV 25304
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

MRS. CARI STOVER NP-C
Nurse Practitioner
4307 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 205-6123
STACIE BOWEN APRN-CNP
Nurse Practitioner (Family)
4307 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 205-6123
KENNY NGUYEN DDS
Dentist (Oral and Maxillofacial Surgery)
4307 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 720-7819

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 1447711858. It was assigned to this organization in the NPPES registry on March 28, 2019. 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 4307 Maccorkle Ave SE, Charleston, WV 25304. The listed phone number is (304) 345-1092.

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 a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 51D2169104) is associated with this NPI, valid through July 15, 2027. 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 and UnitedHealthcare 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 with the weekly NPPES data releases published by CMS.