| LCA CASE NUMBER | I-200-21120-275863 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-04-30 |
| DECISION DATE | 2021-05-07 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Dentist |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | False |
| LCA CASE EMPLOYMENT START DATE | 2021-05-15 |
| END DATE | 2023-02-09 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 1 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Dental Delivery Systems, PA |
| TRADE NAME DBA | Dental Associates of Savage |
| EMPLOYER ADDRESS1 | 13899 Hwy 13 S |
| EMPLOYER CITY | Savage |
| EMPLOYER STATE | MN |
| EMPLOYER POSTAL CODE | 55378 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 19524402292 |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | Maki |
| EMPLOYER POC FIRST NAME | David |
| EMPLOYER POC JOB TITLE | Dental Director |
| EMPLOYER POC ADDRESS 1 | 13899 Hwy 13 S |
| EMPLOYER POC CITY | Savage |
| EMPLOYER POC STATE | MN |
| EMPLOYER POC POSTAL CODE | 55378 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 19524402292 |
| EMPLOYER POC EMAIL | makid@dentalassociatesmn.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Ostrom |
| AGENT ATTORNEY FIRST NAME | Caroline |
| AGENT ATTORNEY MIDDLE NAME | Elizabeth |
| AGENT ATTORNEY ADDRESS1 | 825 Nicollet Mall |
| AGENT ATTORNEY ADDRESS2 | Suite 401 |
| AGENT ATTORNEY CITY | Minneapolis |
| AGENT ATTORNEY STATE | MN |
| AGENT ATTORNEY POSTAL CODE | 55402 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 16128221901 |
| AGENT ATTORNEY EMAIL ADDRESS | costrom@ostromlawoffice.com |
| LAWFIRM NAME BUSINESS NAME | Ostrom Law Office, LLC |
| STATE OF HIGHEST COURT | MN |
| NAME OF HIGHEST STATE COURT | Minnesota Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 13899 Highway 13 S |
| LCA CASE WORKLOC1 CITY | Savage |
| WORKSITE COUNTY | SCOTT |
| LCA CASE WORKLOC1 STATE | MN |
| WORKSITE POSTAL CODE | 55378 |
| LCA CASE WAGE RATE FROM | 63.97 |
| LCA CASE WAGE RATE TO | 90 |
| LCA CASE WAGE RATE UNIT | Hour |
| PREVAILING WAGE | 63.97 |
| PW UNIT OF PAY | Hour |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2020 - 6/30/2021 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Brooks |
| PREPARER FIRST NAME | Jennifer |
| PREPARER MIDDLE INITIAL | R |
| PREPARER BUSINESS NAME | Ostrom Law Office, LLC |
| PREPARER EMAIL | jbrooks@ostromlawoffice.com |
