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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
Organization subpart
No
Provider details
NPI number
Authorized official
LESLEY MARIE COYNER (CREDENTIALING)
(304) 345-1092
Entity
Organization
Contact information
Practice address
433 CARRIAGE DR, BECKLEY, WV 25801-2805
(304) 256-3777
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
01/06/2020
Last updated
05/29/2025
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