| CASE NUMBER | I-200-24185-172626 |
| CASE STATUS | Certified |
| RECEIVED DATE | 7/3/2024 |
| DECISION DATE | 7/11/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Pediatric Dentist |
| SOC CODE | 29-1029.00 |
| SOC TITLE | Dentists, All Other Specialists |
| FULL TIME POSITION | N |
| BEGIN DATE | 8/23/2024 |
| END DATE | 8/22/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 1 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | DENTAL ASSOCIATES LTD. OF WISCONSIN |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 205 E. WISCONSIN AVENUE |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | MILWAUKEE |
| EMPLOYER STATE | WI |
| EMPLOYER POSTAL CODE | 53202 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | +14147785287 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | HERMAN |
| EMPLOYER POC FIRST NAME | KATHRYN |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | DOCTOR RECRUITMENT MANAGER |
| EMPLOYER POC ADDRESS1 | 2340 DUCK CREEK PARKWAY |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | GREEN BAY |
| EMPLOYER POC STATE | WI |
| EMPLOYER POC POSTAL CODE | 54303 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | +19204311705 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | KHERMAN@DENTALASSOCIATES.COM |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | ROURKE |
| AGENT ATTORNEY FIRST NAME | KELLY |
| AGENT ATTORNEY MIDDLE NAME | R |
| AGENT ATTORNEY ADDRESS1 | 790 N. WATER STREET |
| AGENT ATTORNEY ADDRESS2 | SUITE 2500 |
| AGENT ATTORNEY CITY | MILWAUKEE |
| AGENT ATTORNEY STATE | WI |
| AGENT ATTORNEY POSTAL CODE | 53202 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | +14142716560 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | KRROURKE@MICHAELBEST.COM |
| LAWFIRM NAME BUSINESS NAME | MICHAEL BEST AND FRIEDRICH LLP |
| STATE OF HIGHEST COURT | WI |
| NAME OF HIGHEST STATE COURT | SUPREME COURT |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 545 E. Johnson Street |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Fond du Lac |
| WORKSITE COUNTY | FOND DU LAC |
| WORKSITE STATE | WI |
| WORKSITE POSTAL CODE | 54935 |
| WAGE RATE OF PAY FROM | 150.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | $210.00 |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $81.47 |
| PW UNIT OF PAY | Hour |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | III |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| 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 | Gardner |
| PREPARER FIRST NAME | Heather |
| PREPARER MIDDLE INITIAL | L |
| PREPARER BUSINESS NAME | Michael Best and Friedrich LLP |
| PREPARER EMAIL | hlgardner@michaelbest.com |
| BEGIN DATE CONVERTED | 2025-11-08 |
