=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558221580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KETTERBLAIR DENTAL PARTNERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2025
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 N MILWAUKEE ST STE 530
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53202-5818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-377-3535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 4TH ST # 716
-----------------------------------------------------
City | KEY WEST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33040-3763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-377-3535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SARAH BLAIR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 414-377-3535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------