Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Shamina Khanum, DENTIST

Individual provider General Practice Dentistry · NPI 1053724120

MS. Shamina Khanum, DENTIST is a Dentist in Jackson, Mississippi. Qualified in 1997, 29 years ago. Licensed in Mississippi.

Years since qualifying
29
Licensed in
MS
In the registry since
2014
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Practice location Address checks out

3502 W Northside Dr
Jackson, MS 39213
Phone: (601) 362-5321
Fax: (601) 364-2600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 4090-19 (MS)

Record details

NPI number1053724120
Entity typeIndividual (Type 1)
GenderFemale
Credentials DENTIST
Sole proprietorNo
NPI enumeratedJune 6, 2014
Last updated in NPPESJanuary 15, 2025
Certification dateJanuary 17, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDENTIST
Medical schoolOTHER
Graduated 1997 (29 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Jackson