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

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DRS KRAJEKIAN,BROCK,HENDERSON & DIPRISCO INC
- **Other names:** Mt State Oral & Facial Surgery
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1720734684
- **Legal business name:** DRS KRAJEKIAN,BROCK,HENDERSON & DIPRISCO INC
- **Authorized official:** LESLEY MARIE COYNER (CREDENTIALING)
- **Authorized official phone:** (304) 720-7819

## Contact information

- **Practice address:** 895 E WASHINGTON AVE, VINTON, VA 24179-2105
- **Practice address phone:** (304) 425-8220
- **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:** 03/01/2022
- **Last updated:** 05/30/2025