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DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
NPI 1992766737
Dentist - Oral and Maxillofacial Surgery in Hurricane, WV

Active since March 31, 2006CLIA 51D2058565 · Waiver
100A PRESTIGE PARK DR, HURRICANE, WV 25526(304) 757-0272(304) 757-0273 Get Directions Write a Review

NPPES record last updated: May 29, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 29, 2025, Dec 3, 2020, Jun 15, 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 1992766737) is a healthcare organization registered as an oral and maxillofacial surgery in Hurricane, West Virginia and active in the NPI registry since March 2006. The organization holds a CLIA Waiver certificate valid through May 8, 2027 and lists Lesley Marie Coyner, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1992766737
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameDRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
Location Address100A PRESTIGE PARK DRHurricane, WV 25526
Mailing Address103 Station Place WayHurricane, WV 25526-8747 · (304) 345-1092 · Fax (304) 345-5080
Phone(304) 757-0272
Fax(304) 757-0273
Organization SubpartNo
Authorized OfficialLesley Marie CoynerCredentialing · (304) 720-7819
Enumeration DateMarch 31, 2006
Last NPPES UpdateMay 29, 20253 updates tracked since enumeration
NPPES CertifiedMay 29, 2025
✔ NPI 1992766737 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.
100A PRESTIGE PARK DR, Hurricane, WV 25526
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Other Names 1

Other NameMt. State Oral & Maxillofacial Surgeons

Other Identifiers 3

Medicaid4500012000WA
Other9305402WV · Medicare Ptan
Other000817140WV · Mt. State Bcbs

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 51D2058565

Drs Brock, Henderson, Diprisco, Ravelo & Green · Hurricane, WV
Active · expires May 8, 2027
CLIA Number51D2058565
Laboratory TypeOral & Maxillofacial Surg
Certificate Effective DateMay 9, 2025
Certificate Expiration DateMay 8, 2027
Laboratory DirectorChristy Estep
Laboratory Phone(304) 757-0272
Laboratory LocationDrs Brock, Henderson, Diprisco, Ravelo & Green100 A Prestige Park Suite 100 A, Hurricane, WV 25526
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

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

JOHN E BROCK D.D.S.
Dentist (Oral and Maxillofacial Surgery)
100A PRESTIGE PARK DR
HURRICANE, WV 25526
Putnam County (304) 757-0272

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 1992766737. It was assigned to this organization in the NPPES registry on March 31, 2006. The provider is also known as Mt. State Oral & Maxillofacial Surgeons.

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

Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is located at 100A Prestige Park Dr, Hurricane, WV 25526. The listed phone number is (304) 757-0272.

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 51D2058565) is associated with this NPI, valid through May 8, 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 29, 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.