NPI 1053561779

Drs Brock, Henderson, Di Prisco, Ravelo and Green INC

Organisation Oral and Maxillofacial Surgery (Dentist) Huntington, WV

Practice location

Address: 3135 16th Street Rd Suite 20, Huntington, WV 25701
Phone: (304) 399-1092
Mailing address: 103 Station Place Way, Hurricane, WV 25526-8747

Authorised official

Name: Lesley Marie Coyner
Title: Credentialing
Phone: (304) 720-7819

Registered specialties

Oral and Maxillofacial Surgery (Dentist) Primary

Dental Providers Taxonomy 1223S0112X

Other Dentist providers in West Virginia →

Registry record

NPI: 1053561779
Entity type: Organization
NPI issued: 30 Sep 2008
Record last updated: 29 May 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.