| LCA CASE NUMBER | I-200-20147-599971 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2020-05-26 |
| DECISION DATE | 2020-06-02 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Dentist |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | Y |
| LCA CASE EMPLOYMENT START DATE | 2020-10-01 |
| END DATE | 2023-09-30 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Midwest Dental Kansas, Derby, PA |
| TRADE NAME DBA | Midwest Dental |
| EMPLOYER ADDRESS1 | 1700 E James St |
| EMPLOYER CITY | Derby |
| EMPLOYER STATE | KS |
| EMPLOYER POSTAL CODE | 67037 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 17153183445 |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | Berg |
| EMPLOYER POC FIRST NAME | Jodi |
| EMPLOYER POC MIDDLE NAME | Marie |
| EMPLOYER POC JOB TITLE | Human Resources Director |
| EMPLOYER POC ADDRESS1 | 680 E Hehli Way |
| EMPLOYER POC CITY | Mondovi |
| EMPLOYER POC STATE | WI |
| EMPLOYER POC POSTAL CODE | 54755 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 17153183445 |
| EMPLOYER POC EMAIL | [email protected] |
| AGENT REPRESENTING EMPLOYER | Y |
| AGENT ATTORNEY LAST NAME | Ostrom |
| AGENT ATTORNEY FIRST NAME | Caroline |
| AGENT ATTORNEY MIDDLE NAME | Elizabeth |
| AGENT ATTORNEY ADDRESS1 | 825 Nicollet Mall |
| AGENT ATTORNEY ADDRESS2 | Suite 401 |
| AGENT ATTORNEY CITY | Minneapolis |
| AGENT ATTORNEY STATE | MN |
| AGENT ATTORNEY POSTAL CODE | 55402 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 16128221901.0 |
| AGENT ATTORNEY EMAIL ADDRESS | [email protected] |
| LAWFIRM NAME BUSINESS NAME | Ostrom Law Office, LLC |
| STATE OF HIGHEST COURT | MN |
| NAME OF HIGHEST STATE COURT | Minnesota Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | N |
| WORKSITE ADDRESS1 | 1700 E James St |
| LCA CASE WORKLOC1 CITY | Derby |
| WORKSITE COUNTY | SEDGWICK |
| LCA CASE WORKLOC1 STATE | KS |
| WORKSITE POSTAL CODE | 67037 |
| LCA CASE WAGE RATE FROM | 112986.0 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 112986.0 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2019 - 6/30/2020 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | Y |
| H-1B DEPENDENT | N |
| WILLFUL VIOLATOR | N |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Brooks |
| PREPARER FIRST NAME | Jennifer |
| PREPARER MIDDLE INITIAL | R |
| PREPARER BUSINESS NAME | Ostrom Law Office, LLC |
| PREPARER EMAIL | [email protected] |
