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

NPI #1801435003 in Princeton, West Virginia

Provider Information

NPI Number: 1801435003
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 30, 2025

Practice Location

Address: 220 LOCUST ST
City: Princeton
State: West Virginia
ZIP Code: 24740-3626
Phone: (304) 425-8220

Authorized Official

Name: LESLEY MARIE COYNER
Title: CREDENTIALING
Phone: (304) 345-1092

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery	1223S0112X	Primary

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