| LCA CASE NUMBER | I-200-21166-400512 |
| STATUS | Certified - Withdrawn |
| LCA CASE SUBMIT | 2021-06-15 |
| DECISION DATE | 2022-05-24 |
| ORIGINAL CERT DATE | 2021-06-23 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Dentist |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-06-23 |
| END DATE | 2024-06-22 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 1 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Pediatric Dental Group II, LLC |
| TRADE NAME DBA | Adventure Dental |
| EMPLOYER ADDRESS1 | 2221 E. BIJOU STREET STE. 100 |
| EMPLOYER CITY | COLORADO SPRINGS |
| EMPLOYER STATE | CO |
| EMPLOYER POSTAL CODE | 80909 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 16606244887 |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | Lee |
| EMPLOYER POC FIRST NAME | Jamie |
| EMPLOYER POC JOB TITLE | Provider Relations Coordinator |
| EMPLOYER POC ADDRESS1 | 2221 E. BIJOU STREET STE. 100 |
| EMPLOYER POC CITY | COLORADO SPRINGS |
| EMPLOYER POC STATE | CO |
| EMPLOYER POC POSTAL CODE | 80909 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 17196667331 |
| EMPLOYER POC PHONE EXT | 3138 |
| EMPLOYER POC EMAIL | [email protected] |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Schultz |
| AGENT ATTORNEY FIRST NAME | Jonathan |
| AGENT ATTORNEY MIDDLE NAME | Scott |
| AGENT ATTORNEY ADDRESS1 | 8601 N. Scottsdale Road, Suite 300 |
| AGENT ATTORNEY CITY | Scottsale |
| AGENT ATTORNEY STATE | AZ |
| AGENT ATTORNEY POSTAL CODE | 85253 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 14804295000 |
| AGENT ATTORNEY PHONE EXT | 7112 |
| AGENT ATTORNEY EMAIL ADDRESS | [email protected] |
| LAWFIRM NAME BUSINESS NAME | Kutak Rock LLP |
| STATE OF HIGHEST COURT | AZ |
| NAME OF HIGHEST STATE COURT | Supreme Court of Arizona |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 1200 S. Air Depot Blvd. |
| WORKSITE ADDRESS2 | Suite A |
| LCA CASE WORKLOC1 CITY | Midwest City |
| WORKSITE COUNTY | OKLAHOMA |
| LCA CASE WORKLOC1 STATE | OK |
| WORKSITE POSTAL CODE | 73110 |
| LCA CASE WAGE RATE FROM | 182000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 135283 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2020 - 6/30/2021 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Schultz |
| PREPARER FIRST NAME | Jonathan |
| PREPARER BUSINESS NAME | Kutak Rock LLP |
| PREPARER EMAIL | [email protected] |
