| Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc | |
|
1215 Virginia St E Charleston WV 25301 | |
| (304) 345-1092 | |
| (304) 345-5080 |
| Full Name | Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1215 Virginia St E, Charleston, West Virginia |
| Authorized Official Name and Position | Lesley Marie Coyner (CREDENTIALING) |
| Authorized Official Contact | 3047207819 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc 103 Station Place Way Hurricane WV 25526-8747 Ph: (304) 720-7819 | Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc 1215 Virginia St E Charleston WV 25301 Ph: (304) 345-1092 |
| NPI Number | 1346201183 |
|---|---|
| Provider Enumeration Date | 03/31/2006 |
| Last Update Date | 05/29/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346201183 | NPI | - | NPPES |
| 4500012000 | Medicaid | WV | |
| 000817140 | Other | WV | MT. STATE BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
Kennedy & Richardson Dental Office Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1000 Parkway Rd, Ste. D, Charleston, WV 25309 Phone: 304-744-9717 Fax: 304-744-9733 | |
Drs. Simpson & Guest, Pllc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 Allen Dr, Suite 200, Charleston, WV 25302 Phone: 304-342-4717 Fax: 304-342-4737 | |
Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 869 Oakwood Rd, Charleston, WV 25314 Phone: 304-345-1092 | |
Dr. William Christopher Taylor, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 208 Leon Sullivan Way, Charleston, WV 25301 Phone: 304-342-1181 Fax: 304-342-4009 | |
Dr Robert R Simpson Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 Allen Drive, Suite #300, Charleston, WV 25302 Phone: 304-342-6162 Fax: 304-342-8309 | |
Dr Robert R Simpson Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 Allen Dr, Ste 300, Charleston, WV 25302 Phone: 304-342-6162 Fax: 304-342-8309 | |
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