=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013859909
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS GREEN & HENDERSON INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2026
-----------------------------------------------------
Last Update Date | 04/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1603 FRANKLIN RD SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24016-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-283-4940
-----------------------------------------------------
Fax | 540-283-4941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 STATION PLACE WAY
-----------------------------------------------------
City | HURRICANE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25526-8747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-720-7819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCTS RECEIVABLE DIRECTOR
-----------------------------------------------------
Name | LESLEY COYNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-552-7688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------