Drs Brock, Henderson, Di Prisco, Ravelo and Green INC
NPI #1194364398 in Beckley, West Virginia
Provider Information
- NPI Number
- 1194364398
- Entity Type
- Organization
- Organization Name
- Drs Brock, Henderson, Di Prisco, Ravelo and Green INC
- Primary Specialty
- Dentist - Oral and Maxillofacial Surgery
- Enumeration Date
- Jan 6, 2020
- Last Updated
- May 29, 2025
Practice Location
- Address
- 433 CARRIAGE DR
- City
- Beckley
- State
- West Virginia
- ZIP Code
- 25801-2805
- Phone
- (304) 256-3777
Authorized Official
- Name
- LESLEY MARIE COYNER
- Title
- CREDENTIALING
- Phone
- (304) 345-1092
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery |
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