| LCA CASE NUMBER | I-200-21131-303976 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-05-11 |
| DECISION DATE | 2021-05-18 |
| 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 | 2021-10-01 |
| END DATE | 2024-09-30 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Shalimar Family Dentistry, PLLC |
| EMPLOYER ADDRESS1 | 1 Eleventh Ave |
| EMPLOYER ADDRESS2 | Suite D-3 |
| EMPLOYER CITY | Shalimar |
| EMPLOYER STATE | FL |
| EMPLOYER POSTAL CODE | 32579 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 18506516700 |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | Moeller |
| EMPLOYER POC FIRST NAME | Kristie |
| EMPLOYER POC MIDDLE NAME | Jo |
| EMPLOYER POC JOB TITLE | Business Manager |
| EMPLOYER POC ADDRESS 1 | 10 Windemere CT NW |
| EMPLOYER POC CITY | Fort Walton Beach |
| EMPLOYER POC STATE | FL |
| EMPLOYER POC POSTAL CODE | 32547 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 17162203297 |
| EMPLOYER POC EMAIL | anthonykristie@gmail.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Novak |
| AGENT ATTORNEY FIRST NAME | Amy |
| AGENT ATTORNEY MIDDLE NAME | Jill |
| AGENT ATTORNEY ADDRESS1 | 2077 North Frontage Road |
| AGENT ATTORNEY ADDRESS2 | Suite #111 |
| AGENT ATTORNEY CITY | Vail |
| AGENT ATTORNEY STATE | CO |
| AGENT ATTORNEY POSTAL CODE | 81657 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 19703066476 |
| AGENT ATTORNEY EMAIL ADDRESS | amy@novaklawoffice.com |
| LAWFIRM NAME BUSINESS NAME | Novak Law Office |
| STATE OF HIGHEST COURT | CO |
| NAME OF HIGHEST STATE COURT | Colorado Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 1 Eleventh Ave |
| WORKSITE ADDRESS2 | Suite D-3 |
| LCA CASE WORKLOC1 CITY | Shalimar |
| WORKSITE COUNTY | OKALOOSA |
| LCA CASE WORKLOC1 STATE | FL |
| WORKSITE POSTAL CODE | 32579 |
| LCA CASE WAGE RATE FROM | 69.5 |
| LCA CASE WAGE RATE TO | 69.51 |
| LCA CASE WAGE RATE UNIT | Hour |
| PREVAILING WAGE | 69.5 |
| PW UNIT OF PAY | Hour |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2020 - 6/30/2021 |
| TOTAL WORKSITE LOCATIONS | 2 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Moeller |
| PREPARER FIRST NAME | Kristie |
| PREPARER MIDDLE INITIAL | J |
| PREPARER BUSINESS NAME | Shalimar Family Dentistry |
| PREPARER EMAIL | anthonykristie@gmail.com |
