Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1053724120 Individual Practitioner Female Practitioner

Shamina Khanum , DENTIST

Dentist - General Practice • Jackson, MS

Professional Overview & Biography Verified Profile Summary

Shamina Khanum, DENTIST is a certified Dentist - General Practice practicing in Jackson, MS. With approximately 29 years of clinical experience since completing medical education in 1997, Shamina Khanum delivers high-quality medical care to the local community at 3502 WEST NORTHSIDE DRIVE.

Shamina Khanum does not directly accept Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

3502 West Northside Drive

Jackson, MS 39213

Telephone 6013625321
Fax 6013642600
Associated Practice Facility / Clinic

Medicare Profile & Education

Medical School

Other

Graduation Year

1997

Medicare Assignment

Not Specified

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Jackson, MS

Senior Veteran Specialist (>20 Yrs)
Practitioner Clinical Experience
29 Yrs Matches City Avg
City Avg: 29.0 Yrs
State Avg: 20.3 Yrs
Regional Practice Density
96 Specialists

Practicing in Jackson, MS (895 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Khanum (29 Years) 29 Yrs
Jackson Specialty Average (29.0 Years) 29.0 Yrs

Medical Specialties & State Licenses

CMS Verified: 2023-01-17
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MS 4090-19

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Tiffani Mcknight

Social Worker - Clinical

NPI 1003388968
Katrice Andrews , FNP-C

Nurse Practitioner - Family

NPI 1013451780

Family Nurse Practitioner (Certified)

Ericia Cannon , NURSE PRACTITONER

Nurse Practitioner - Family

NPI 1013473891

NURSEPRACTITONER

Jequetta Mclaurin , FNP

Nurse Practitioner - Family

NPI 1013698513

Family Nurse Practitioner

Dr. Chad Rhoden , MD

Family Medicine

NPI 1043387764

Doctor of Medicine (M.D.)

Tina Hodges , LMSW

Social Worker

NPI 1073237665

Licensed Master Social Worker

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

19 Historical Events
📍
Updated Practice Location January 15, 2025

Registered at 3502 WEST NORTHSIDE DRIVE, JACKSON, MS 39213 (Tel: 6013625321)

📍
Updated Business Mailing Address January 15, 2025

Registered at 3502 WEST NORTHSIDE DRIVE, JACKSON HINDS COMPREHENSIVE, TUPELO, MS 38801 (Tel: 6013625321)

📍
Updated Practice Location March 21, 2024

Registered at 401 S GLOSTER ST STE 101, SUNNYBROOK DENTISTRY, TUPELO, MS 38801 (Tel: 6623465906)

📍
Updated Business Mailing Address March 21, 2024

Registered at 401 S GLOSTER ST STE 101, SUNNYBROOK DENTISTRY, TUPELO, MS 38801 (Tel: 6623465906)

📍
Updated Practice Location January 17, 2023

Registered at 3804 HOSPITAL RD, HEALTHY SMILE FAMILY DENTISTRY, PASCAGOULA, MS 39581 (Tel: 2286962611)

📍
Updated Business Mailing Address January 17, 2023

Registered at 3804 HOSPITAL RD, HEALTHY SMILE FAMILY DENTISTRY, PASCAGOULA, MS 39581 (Tel: 2286962611)

📍
Updated Practice Location August 29, 2022

Registered at 3999 NORTH GLOSTER ST STE D, ASPEN DENTAL, TUPELO, MS 38804 (Tel: 6627782002)

📍
Updated Business Mailing Address August 29, 2022

Registered at 3999 NORTH GLOSTER ST STE D, ASPEN DENTAL, TUPELO, MS 38804 (Tel: 6627782002)

📍
Updated Practice Location July 30, 2021

Registered at 60024 OLIVE STREET ACCESS FAMILY DENTAL CLINIC, SMITHVILLE, MS 388709719 (Tel: 6626517111)

📍
Updated Business Mailing Address July 30, 2021

Registered at 60024 OLIVE STREET ACCESS FAMILY DENTAL CLINIC, SMITHVILLE, MS 388709719 (Tel: 6626517111)

📍
Updated Business Mailing Address August 13, 2020

Registered at 940 CHURCH RD W, SOUTHAVEN, MS 38671 (Tel: 6622538027)

👤
Provider Name / Credentials Updated August 13, 2020

Recorded as SHAMINA KHANUM, DENTIST

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 13, 2020

Dentist (License #4090-19 in MS)

NPI Profile Active June 06, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location June 06, 2014

Registered at 1100 FLORIDA AVE,, LSU HEALTH SCIENCE CENTER (DENTAL SCHOOL), NEW ORLEANS, LA 70119 (Tel: 5049418270)

📍
Updated Business Mailing Address June 06, 2014

Registered at 3443 EDENBORN AVENUE,, APT #215, METAIRIE, LA 70002 (Tel: 7326750620)

👤
Provider Name / Credentials Updated June 06, 2014

Recorded as SHAMINA KHANUM

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 06, 2014

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration June 06, 2014

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1053724120
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 06, 2014
Last Update: January 15, 2025
Sole Proprietor: No

Mailing Address

3502 West Northside Drive, Jackson Hinds Comprehensive

Tupelo, MS 38801

Phone: 6013625321

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.