| CASE NUMBER | I-200-24268-359614 |
| CASE STATUS | Certified |
| RECEIVED DATE | 9/24/2024 |
| DECISION DATE | 10/1/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Periodontist |
| SOC CODE | 29-1029.00 |
| SOC TITLE | Dentists, All Other Specialists |
| FULL TIME POSITION | N |
| BEGIN DATE | 10/1/2024 |
| END DATE | 9/30/2027 |
| 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 | M&R Dental PLLC |
| TRADE NAME DBA | Stephens Dentistry |
| EMPLOYER ADDRESS1 | 1560 Sherman Ave. |
| EMPLOYER ADDRESS2 | Suite 902 |
| EMPLOYER CITY | Evanston |
| EMPLOYER STATE | IL |
| EMPLOYER POSTAL CODE | 60201 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 18478648151 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | Licar |
| EMPLOYER POC FIRST NAME | Coleen-Shannon |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Business Manager |
| EMPLOYER POC ADDRESS1 | 1560 Sherman Ave. |
| EMPLOYER POC ADDRESS2 | Suite 902 |
| EMPLOYER POC CITY | Evanston |
| EMPLOYER POC STATE | IL |
| EMPLOYER POC POSTAL CODE | 60201 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 18478648151 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | coleen@stephensdentistry.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Gunn |
| AGENT ATTORNEY FIRST NAME | Matthew |
| AGENT ATTORNEY MIDDLE NAME | P |
| AGENT ATTORNEY ADDRESS1 | 101 South Fifth Street |
| AGENT ATTORNEY ADDRESS2 | Suite 2500 |
| AGENT ATTORNEY CITY | Louisville |
| AGENT ATTORNEY STATE | KY |
| AGENT ATTORNEY POSTAL CODE | 60201 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 15025402377 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | matthew.gunn@dinsmore.com |
| LAWFIRM NAME BUSINESS NAME | Dinsmore and Shohl LLP |
| STATE OF HIGHEST COURT | KY |
| NAME OF HIGHEST STATE COURT | Supreme Court of Kentucky |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 1560 Sherman Ave. |
| WORKSITE ADDRESS2 | Suite 902 |
| WORKSITE CITY | Evanston |
| WORKSITE COUNTY | COOK |
| WORKSITE STATE | IL |
| WORKSITE POSTAL CODE | 60201 |
| WAGE RATE OF PAY FROM | $68.62 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $68.62 |
| 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 | Han |
| PREPARER FIRST NAME | Silver |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Dinsmore and Shohl LLP |
| PREPARER EMAIL | silver.han@dinsmore.com |
| BEGIN DATE CONVERTED | 2024-10-01 |
