MEDICARE: MY SMILE KELLER DENTISTRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1437087509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY SMILE KELLER DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	1517 WILLIS LN
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	796 KELLER PKWY STE A
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-2433
Country	:	US
Telephone Number	:	817-431-3391
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHAEL COLANGELO
Credential	:	DDS
Telephone Number	:	682-667-7225

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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