| CASE NUMBER | I-200-24340-520262 |
| CASE STATUS | Certified |
| RECEIVED DATE | 12/5/2024 |
| DECISION DATE | 12/12/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | ASSOCIATE DENTIST |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | Y |
| BEGIN DATE | 1/2/2025 |
| END DATE | 1/1/2028 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 1 |
| EMPLOYER NAME | THOMAS KENNEDY DDS OF MISSOURI II LLC |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 5863 Suemandy Road |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | St. Peters |
| EMPLOYER STATE | MO |
| EMPLOYER POSTAL CODE | 63376 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 15738385474 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | CRUZ |
| EMPLOYER POC FIRST NAME | PEGGY |
| EMPLOYER POC MIDDLE NAME | GRACE |
| EMPLOYER POC JOB TITLE | MANAGER, CLINICAL RECRUITMENT |
| EMPLOYER POC ADDRESS1 | 629 DAVIS DRIVE |
| EMPLOYER POC ADDRESS2 | SUITE 300 |
| EMPLOYER POC CITY | MORRISVILLE |
| EMPLOYER POC STATE | NC |
| EMPLOYER POC POSTAL CODE | 27560 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 19188018124 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | GRACIE.CRUZ@AFFORDABLECARE.COM |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | KIHUMBA |
| AGENT ATTORNEY FIRST NAME | BARBARA |
| AGENT ATTORNEY MIDDLE NAME | W. |
| AGENT ATTORNEY ADDRESS1 | ONE WEST 4TH STREET |
| AGENT ATTORNEY ADDRESS2 | SUITE 850 |
| AGENT ATTORNEY CITY | WINSTON-SALEM |
| AGENT ATTORNEY STATE | NC |
| AGENT ATTORNEY POSTAL CODE | 27101 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 14042306755 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | BKIHUMBA@CONSTANGY.COM |
| LAWFIRM NAME BUSINESS NAME | CONSTANGY, BROOKS, SMITH & PROPHETE, LLP |
| STATE OF HIGHEST COURT | GA |
| NAME OF HIGHEST STATE COURT | SUPREME COURT OF GEORGIA |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 5863 Suemandy Road |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | St. Peters |
| WORKSITE COUNTY | ST CHARLES |
| WORKSITE STATE | MO |
| WORKSITE POSTAL CODE | 63376 |
| WAGE RATE OF PAY FROM | $105,706.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | $175,000.00 |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $105,706.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | I |
| 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 | WILLIAMS |
| PREPARER FIRST NAME | MARIE |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Constangy, Brooks, Smith and Prophete LLP |
| PREPARER EMAIL | MWILLIAMS@CONSTANGY.COM |
| BEGIN DATE CONVERTED | 2025-01-02 |
