| CASE NUMBER | I-200-24268-360379 |
| CASE STATUS | Certified |
| RECEIVED DATE | 9/24/2024 |
| DECISION DATE | 10/1/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Associate General Dentist |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | Y |
| BEGIN DATE | 1/21/2025 |
| END DATE | 1/20/2028 |
| 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 | Modern Dental Professionals - Dallas Forth Worth, P.C. |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 675 Anton Blvd |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Costa Mesa |
| EMPLOYER STATE | CA |
| EMPLOYER POSTAL CODE | 92626 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 17145889094 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62121 |
| EMPLOYER POC LAST NAME | Zavatsky |
| EMPLOYER POC FIRST NAME | Jacqueline |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | SR. Recruiting & Immigration Support Coordinator |
| EMPLOYER POC ADDRESS1 | 675 ANTON BLVD |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | COSTA MESA |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 92626 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 19493778644 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | Jackie.Zavatsky@smilebrands.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Wu |
| AGENT ATTORNEY FIRST NAME | Tiffany |
| AGENT ATTORNEY MIDDLE NAME | Chang |
| AGENT ATTORNEY ADDRESS1 | 18401 Von Karman Ave. |
| AGENT ATTORNEY ADDRESS2 | Suite 255 |
| AGENT ATTORNEY CITY | Irvine |
| AGENT ATTORNEY STATE | CA |
| AGENT ATTORNEY POSTAL CODE | 92612 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 19492610209 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | llong@fragomen.com |
| LAWFIRM NAME BUSINESS NAME | Fragomen, Del Rey, Bernsen & Loewy, LLP |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | Supreme |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 2700 E. El Dorado Parkway |
| WORKSITE ADDRESS2 | Suite 106 |
| WORKSITE CITY | Little Elm |
| WORKSITE COUNTY | DENTON |
| WORKSITE STATE | TX |
| WORKSITE POSTAL CODE | 75068 |
| WAGE RATE OF PAY FROM | $160,389.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $123,344.00 |
| 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 | Long |
| PREPARER FIRST NAME | Lee Ann |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Fragomen, Del Rey, Bernsen & Loewy, LLP |
| PREPARER EMAIL | llong@fragomen.com |
| BEGIN DATE CONVERTED | 2025-01-21 |
