DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
NPI 1801435003
Dentist - Oral and Maxillofacial Surgery in Princeton, WV

Q: 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.

Active since January 06, 2020CLIA 51D2292349 · Waiver

220 LOCUST ST, PRINCETON, WV 24740(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, Dec 3, 2020, Jan 6, 2020 (3 updates tracked since 2020).

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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 1801435003) is a healthcare organization registered as an oral and maxillofacial surgery in Princeton, West Virginia and active in the NPI registry since January 2020. The organization holds a CLIA Waiver certificate valid through October 23, 2027 and lists Lesley Marie Coyner, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1801435003

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameDRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC

Location Address220 LOCUST STPrinceton, WV 24740-3626

Mailing Address103 Station Place WayHurricane, WV 25526-8747 · (304) 720-7819

Phone(304) 425-8220

Organization SubpartNo

Authorized OfficialLesley Marie CoynerCredentialing · (304) 345-1092

Enumeration DateJanuary 6, 2020

Last NPPES UpdateMay 30, 20253 updates tracked since enumeration

NPPES CertifiedMay 30, 2025

✔ NPI 1801435003 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.

220 LOCUST ST, Princeton, WV 24740

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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 ›

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 51D2292349

Drs Brock, Henderson, Diprisco, Ravelo & Green · Princeton, WV

Active · expires Oct 23, 2027

CLIA Number51D2292349

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateOctober 24, 2025

Certificate Expiration DateOctober 23, 2027

Laboratory DirectorChristy Estep

Laboratory Phone(304) 667-7119

Laboratory LocationDrs Brock, Henderson, Diprisco, Ravelo & Green220 Locust Street, Princeton, WV 24740

CLIA data matches this NPI record on: Address

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 1801435003. It was assigned to this organization in the NPPES registry on January 6, 2020.

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

Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is located at 220 Locust St, Princeton, WV 24740. 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 51D2292349) is associated with this NPI, valid through October 23, 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 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 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.