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DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
NPI 1720734684
Dentist - Oral and Maxillofacial Surgery in Vinton, VA

Active since March 01, 2022CLIA 49D2317809 · Waiver
895 E WASHINGTON AVE, VINTON, VA 24179(304) 425-8220 Get Directions Write a Review

NPPES record last updated: May 30, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 30, 2025, Mar 1, 2022 (2 updates tracked since 2022).

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 1720734684), doing business as Mt State Oral & Facial Surgery, is a healthcare organization registered as an oral and maxillofacial surgery in Vinton, Virginia and active in the NPI registry since March 2022. The organization holds a CLIA Waiver certificate valid through January 30, 2027 and lists Lesley Marie Coyner, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1720734684
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameDRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
Location Address895 E WASHINGTON AVEVinton, VA 24179-2105
Mailing Address103 Station Place WayHurricane, WV 25526-8747 · (304) 720-7819
Phone(304) 425-8220
Organization SubpartYesParent: Drs Krajekian,brock,henderson & Diprisco Inc
Authorized OfficialLesley Marie CoynerCredentialing · (304) 720-7819
Enumeration DateMarch 1, 2022
Last NPPES UpdateMay 30, 20252 updates tracked since enumeration
NPPES CertifiedMay 30, 2025
✔ NPI 1720734684 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.
895 E WASHINGTON AVE, Vinton, VA 24179
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

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 49D2317809

Drs Brock, Henderson, Dprisco,ravelo&green · Vinton, VA
Active · expires Jan 30, 2027
CLIA Number49D2317809
Laboratory TypePhysician Office
Certificate Effective DateJanuary 31, 2025
Certificate Expiration DateJanuary 30, 2027
Laboratory DirectorChristy P. Estep
Laboratory Phone(540) 790-6050
Laboratory LocationDrs Brock, Henderson, Dprisco,ravelo&green895 E Washington Ave, Vinton, VA 24179
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 4

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

DR. GEORGE KEVORKIAN JR. DDS
Dentist (Oral and Maxillofacial Pathology)
895 E WASHINGTON AVE
VINTON, VA 24179
Roanoke County (540) 344-7252
GEORGE KEVORKIAN JR DDS PC
Dentist (Oral and Maxillofacial Pathology)
895 E WASHINGTON AVE
VINTON, VA 24179
Roanoke County (540) 344-7252
DRS GREEN & HENDERSON INC
Dentist (Oral and Maxillofacial Surgery)
895 E WASHINGTON AVE
VINTON, VA 24179
Roanoke County (540) 790-6050
DR. JOHN MARSHALL GREEN III DDS FACS
Dentist (Oral and Maxillofacial Surgery)
895 E WASHINGTON AVE
VINTON, VA 24179
Roanoke County (540) 344-7252

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 1720734684. It was assigned to this organization in the NPPES registry on March 1, 2022. 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 895 E Washington Ave, Vinton, VA 24179. The listed phone number is (304) 425-8220.

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 49D2317809) is associated with this NPI, valid through January 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

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 14 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.