| CASE NUMBER | I-200-24141-015175 |
| CASE STATUS | Certified |
| RECEIVED DATE | 5/20/2024 |
| DECISION DATE | 5/28/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Dentist |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | Y |
| BEGIN DATE | 10/1/2024 |
| END DATE | 9/30/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | NICHOLAS DELISLE DDS P.L.L.C. |
| TRADE NAME DBA | HARBOR KIDS DENTAL |
| EMPLOYER ADDRESS1 | 216 W. Heron Street |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Aberdeen |
| EMPLOYER STATE | WA |
| EMPLOYER POSTAL CODE | 98520 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 13605325437 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 6212 |
| EMPLOYER POC LAST NAME | Reams |
| EMPLOYER POC FIRST NAME | Susanne |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Director of HR & Compliance |
| EMPLOYER POC ADDRESS1 | 7887 E. Belleview Ave. |
| EMPLOYER POC ADDRESS2 | Suite 250 |
| EMPLOYER POC CITY | Englewood |
| EMPLOYER POC STATE | CO |
| EMPLOYER POC POSTAL CODE | 80111 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 17206034787 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | sreams@lonepeakdentalgroup.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Wagner |
| AGENT ATTORNEY FIRST NAME | David |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 1900 Wazee Street |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Denver |
| AGENT ATTORNEY STATE | CO |
| AGENT ATTORNEY POSTAL CODE | 80202 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 12146869980 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | dave.wagner@bal.com |
| LAWFIRM NAME BUSINESS NAME | Berry Appleman & Leiden LLP |
| STATE OF HIGHEST COURT | IL |
| NAME OF HIGHEST STATE COURT | Supreme Court of Illinois |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 216 W. Heron Street |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Aberdeen |
| WORKSITE COUNTY | GRAYS HARBOR |
| WORKSITE STATE | WA |
| WORKSITE POSTAL CODE | 98520 |
| WAGE RATE OF PAY FROM | 250000 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $210,142.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | III |
| PW OES YEAR | 7/1/2023 - 6/30/2024 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Luckewicz |
| PREPARER FIRST NAME | Camie |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Berry Appleman & Leiden, LLP |
| PREPARER EMAIL | cluckewicz@bal.com |
| BEGIN DATE CONVERTED | 2024-01-10 |
