Provider Demographics
NPI:1689082646
Name:HEFFNER, MARCUS SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:SCOTT
Last Name:HEFFNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 IRVINE AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6604
Mailing Address - Country:US
Mailing Address - Phone:949-335-7303
Mailing Address - Fax:
Practice Address - Street 1:2675 IRVINE AVE STE 116
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-6604
Practice Address - Country:US
Practice Address - Phone:949-335-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0257021223P0221X, 122300000X
CA103129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0363898Medicaid