# DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194364398
- **Authorized official:** LESLEY MARIE COYNER (CREDENTIALING)
- **Authorized official phone:** (304) 345-1092

## Contact information

- **Practice address:** 433 CARRIAGE DR, BECKLEY, WV 25801-2805
- **Practice address phone:** (304) 256-3777
- **Mailing address:** 103 STATION PLACE WAY, HURRICANE, WV 25526-8747
- **Mailing address phone:** (304) 720-7819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 01/06/2020
- **Last updated:** 05/29/2025