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Organization
DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
Active
Organization
DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
Active
Other names
Mt State Oral & Facial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
LESLEY MARIE COYNER (CREDENTIALING)
(304) 345-1092
Entity
Organization
Contact information
Practice address
2301 LEXINGTON AVE STE 120, ASHLAND, KY 41101-2807
(304) 399-1092
Mailing address
103 STATION PLACE WAY, HURRICANE, WV 25526-8747
(304) 720-7819
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
12/31/2018
Last updated
05/29/2025
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