| LCA CASE NUMBER | I-200-21173-418558 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-06-22 |
| DECISION DATE | 2021-06-29 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | General Dentist |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-08-16 |
| END DATE | 2024-08-15 |
| TOTAL WORKER POSITIONS | 2 |
| NEW EMPLOYMENT | 2 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | La Clinica de los Campesinos, Inc. |
| TRADE NAME DBA | Family Health/La Clinica |
| EMPLOYER ADDRESS1 | 400 S. Townline Rd. |
| EMPLOYER ADDRESS2 | PO Box 1440 |
| EMPLOYER CITY | Wautoma |
| EMPLOYER STATE | WI |
| EMPLOYER POSTAL CODE | 54982 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 19207879406 |
| NAICS CODE | 621498 |
| EMPLOYER POC LAST NAME | Waldvogel |
| EMPLOYER POC FIRST NAME | Laura |
| EMPLOYER POC MIDDLE NAME | Ann |
| EMPLOYER POC JOB TITLE | Chief Executive officer |
| EMPLOYER POC ADDRESS 1 | 400 S. Townline Rd. |
| EMPLOYER POC ADDRESS 2 | PO Box 1440 |
| EMPLOYER POC CITY | Wautoma |
| EMPLOYER POC STATE | WI |
| EMPLOYER POC POSTAL CODE | 54982 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 19207879406 |
| EMPLOYER POC EMAIL | Laura.Waldvogel@famhealth.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Santa Maria |
| AGENT ATTORNEY FIRST NAME | Monica |
| AGENT ATTORNEY ADDRESS1 | 354 W. Main Street |
| AGENT ATTORNEY CITY | Madison |
| AGENT ATTORNEY STATE | WI |
| AGENT ATTORNEY POSTAL CODE | 53703 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 16082573152 |
| AGENT ATTORNEY EMAIL ADDRESS | admin@santamaria-legal.com |
| LAWFIRM NAME BUSINESS NAME | Santa Maria Law Office, LLC |
| STATE OF HIGHEST COURT | WI |
| NAME OF HIGHEST STATE COURT | Supreme Court of Wisconsin |
| WORKSITE WORKERS | 2 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | Mauston Dental Center |
| WORKSITE ADDRESS2 | 880 Harriot Drive |
| LCA CASE WORKLOC1 CITY | Mauston |
| WORKSITE COUNTY | JUNEAU |
| LCA CASE WORKLOC1 STATE | WI |
| WORKSITE POSTAL CODE | 53948 |
| LCA CASE WAGE RATE FROM | 150000 |
| LCA CASE WAGE RATE TO | 175000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 73528 |
| PW UNIT OF PAY | Year |
| 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 |
