Healthcare Provider Details

I. General information

NPI: 1104749811
Provider Name (Legal Business Name): LATINA CLINICA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CHINA GRADE LOOP
BAKERSFIELD CA
93308-1707
US

IV. Provider business mailing address

215 CHINA GRADE LOOP
BAKERSFIELD CA
93308-1707
US

V. Phone/Fax

Practice location:
  • Phone: 661-535-4389
  • Fax: 661-535-4381
Mailing address:
  • Phone: 661-535-4389
  • Fax: 661-535-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK ANTHONY JOHNSON
Title or Position: DENTIST
Credential: DDS
Phone: 661-535-4389