Organization
DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
Active
Parent organization
DRS KRAJEKIAN,BROCK,HENDERSON & DIPRISCO INC
Other names
Mt State Oral & Facial Surgery
Organization subpart
Yes
Provider details
NPI number
Legal business name
DRS KRAJEKIAN,BROCK,HENDERSON & DIPRISCO INC
Authorized official
LESLEY MARIE COYNER (CREDENTIALING)
(304) 720-7819
Entity
Organization
Contact information
Practice address
895 E WASHINGTON AVE, VINTON, VA 24179-2105
(304) 425-8220
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
—
—
Other
Enumeration date
03/01/2022
Last updated
05/30/2025
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