Healthcare Provider Details

I. General information

NPI: 1477466803
Provider Name (Legal Business Name): DEKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 STATE ST
CAYCE SC
29033-4049
US

IV. Provider business mailing address

1501 STATE ST
CAYCE SC
29033-4049
US

V. Phone/Fax

Practice location:
  • Phone: 704-771-3320
  • Fax:
Mailing address:
  • Phone: 704-771-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: DENTON DICARLO
Title or Position: OWNER
Credential:
Phone: 704-771-3320