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Organization
LAKESIDE ENT & FACIAL PLASTIC SURGERY LLC
Active
Organization
LAKESIDE ENT & FACIAL PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERED M MANCELL DO (PHYSICIAN/MEDICAL DIRECTOR)
(605) 880-5965
Entity
Organization
Contact information
Practice address
1516 4TH ST NE, WATERTOWN, SD 57201-6824
(605) 880-5965
Mailing address
1516 4TH ST NE, WATERTOWN, SD 57201-6824
(605) 880-5965
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
—
NULL
Other
Enumeration date
10/09/2026
Last updated
10/09/2026
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