| CASE NUMBER | I-200-25076-780752 |
| CASE STATUS | Certified |
| RECEIVED DATE | 3/17/2025 |
| DECISION DATE | 3/24/2025 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | DATABASE ADMINISTRATOR |
| SOC CODE | 15-1242.00 |
| SOC TITLE | Database Administrators |
| FULL TIME POSITION | Y |
| BEGIN DATE | 9/10/2025 |
| END DATE | 9/9/2028 |
| 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 | LAKEWOOD FAMILY DENTAL INC |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 4512 PARNELL AVENUE |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | FORT WAYNE |
| EMPLOYER STATE | IN |
| EMPLOYER POSTAL CODE | 46825 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 12605895505 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | KAKOLLU |
| EMPLOYER POC FIRST NAME | SRINIVASULU |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | DIRECTOR |
| EMPLOYER POC ADDRESS1 | 4512 PARNELL AVENUE |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | FORT WAYNE |
| EMPLOYER POC STATE | IN |
| EMPLOYER POC POSTAL CODE | 46825 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 12605895505 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | skakollu@lakewood-familydental.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 |
| AGENT ATTORNEY ADDRESS2 | #70 |
| 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 | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 4512 PARNELL AVENUE |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | FORT WAYNE |
| WORKSITE COUNTY | ALLEN |
| WORKSITE STATE | IN |
| WORKSITE POSTAL CODE | 46825 |
| WAGE RATE OF PAY FROM | $66,206.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $66,206.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| 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 | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2025-09-10 |
