| CASE NUMBER | I-200-24074-799456 |
| CASE STATUS | Certified - Withdraw |
| RECEIVED DATE | 3/14/2024 |
| DECISION DATE | 4/1/2024 |
| ORIGINAL CERT DATE | 3/21/2024 |
| VISA CLASS | H-1B |
| JOB TITLE | ASSOCIATE GENERAL DENTIST |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | Y |
| BEGIN DATE | 9/13/2024 |
| END DATE | 9/12/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Simply Dental Management, Inc. |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 87 Elm St. |
| EMPLOYER ADDRESS2 | Suite 302 |
| EMPLOYER CITY | Hopkinton |
| EMPLOYER STATE | MA |
| EMPLOYER POSTAL CODE | 1748 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 15085898270 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | Bousquet |
| EMPLOYER POC FIRST NAME | Margaret |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Senior Manager of Business Affairs |
| EMPLOYER POC ADDRESS1 | 87 Elm St. |
| EMPLOYER POC ADDRESS2 | Suite 302 |
| EMPLOYER POC CITY | Hopkinton |
| EMPLOYER POC STATE | MA |
| EMPLOYER POC POSTAL CODE | 1748 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 19788210742 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | mbousquet@simplydentalmanagment.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Lego |
| AGENT ATTORNEY FIRST NAME | Kellie |
| AGENT ATTORNEY MIDDLE NAME | Nicole |
| AGENT ATTORNEY ADDRESS1 | 1177 Annapolis Road, #70 |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Odenton |
| AGENT ATTORNEY STATE | MD |
| AGENT ATTORNEY POSTAL CODE | 21113 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 12403900600 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | Kellie@mvplg.com |
| LAWFIRM NAME BUSINESS NAME | MVP Law Group PA |
| STATE OF HIGHEST COURT | MD |
| NAME OF HIGHEST STATE COURT | SUPREME COURT OF MARYLAND |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | Yes |
| SECONDARY ENTITY BUSINESS NAME | Super Dental of Fitchburg PLLC |
| WORKSITE ADDRESS1 | 130 Water Street |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Fitchburg |
| WORKSITE COUNTY | FITCHBURG CITY |
| WORKSITE STATE | MA |
| WORKSITE POSTAL CODE | 1420 |
| WAGE RATE OF PAY FROM | 147971 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $134,035.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2023 - 6/30/2024 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 2 |
| 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 | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2025-01-09 |
