Healthcare Provider Details

I. General information

NPI: 1154239416
Provider Name (Legal Business Name): GORDON KELCH DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3739 MT BAKER HWY
EVERSON WA
98247-9406
US

IV. Provider business mailing address

3739 MT BAKER HWY
EVERSON WA
98247-9406
US

V. Phone/Fax

Practice location:
  • Phone: 360-592-1100
  • Fax:
Mailing address:
  • Phone: 224-623-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GORDON ALEXANDER KELCH
Title or Position: DENTIST
Credential: DDS
Phone: 224-623-3123