| CASE NUMBER | I-200-24304-441438 |
| CASE STATUS | Certified |
| RECEIVED DATE | 10/29/2024 |
| DECISION DATE | 11/5/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Dentist |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | N |
| BEGIN DATE | 1/3/2025 |
| END DATE | 1/2/2028 |
| 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 | Mason Dental, P.C. |
| TRADE NAME DBA | Richmond Dental |
| EMPLOYER ADDRESS1 | 72 Bridge Street |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Richmond |
| EMPLOYER STATE | VT |
| EMPLOYER POSTAL CODE | 5477 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 18027524494 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62121 |
| EMPLOYER POC LAST NAME | Mason |
| EMPLOYER POC FIRST NAME | Jonathan |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Chief Clinical Officer |
| EMPLOYER POC ADDRESS1 | 72 Bridge Street |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Richmond |
| EMPLOYER POC STATE | VT |
| EMPLOYER POC POSTAL CODE | 5477 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 18027524494 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | jmason@selectdentalmanagement.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Fillo |
| AGENT ATTORNEY FIRST NAME | Allison |
| AGENT ATTORNEY MIDDLE NAME | Ahern |
| AGENT ATTORNEY ADDRESS1 | One Boston Place |
| AGENT ATTORNEY ADDRESS2 | 37th Floor |
| AGENT ATTORNEY CITY | Boston |
| AGENT ATTORNEY STATE | MA |
| AGENT ATTORNEY POSTAL CODE | 2108 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 16175893836 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | aahernfillo@davismalm.com |
| LAWFIRM NAME BUSINESS NAME | Davis, Malm & D'Agostine, P.C. |
| STATE OF HIGHEST COURT | MA |
| NAME OF HIGHEST STATE COURT | Massachusetts Supreme Judicial Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 72 Bridge Street |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Richmond |
| WORKSITE COUNTY | CHITTENDEN |
| WORKSITE STATE | VT |
| WORKSITE POSTAL CODE | 5477 |
| WAGE RATE OF PAY FROM | $74.94 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $74.94 |
| PW UNIT OF PAY | Hour |
| 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 | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2025-01-03 |
