Drs Brock, Henderson, Di Prisco, Ravelo and Green Inc
NPI 1447711858ActiveOrganization· Dentist, Oral and Maxillofacial Surgery· Charleston, WV
Dentist, Oral and Maxillofacial Surgery in Charleston, West Virginia, registered in NPPES in March 2019. The authorized official on file is Lesley Marie Coyner, Credentialing.
Overview
| NPI | 1447711858 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 28, 2019 |
| Last updated in NPPES | May 30, 2025 |
| Certified by provider | May 30, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, Oral and Maxillofacial Surgery Primary | 1223S0112X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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