Healthcare Provider Details

I. General information

NPI: 1689082646
Provider Name (Legal Business Name): MARCUS SCOTT HEFFNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 IRVINE AVE STE 116
COSTA MESA CA
92627-6604
US

IV. Provider business mailing address

2675 IRVINE AVE STE 116
COSTA MESA CA
92627-6604
US

V. Phone/Fax

Practice location:
  • Phone: 949-335-7303
  • Fax:
Mailing address:
  • Phone: 949-335-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30.025702
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025702
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number103129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: