| LCA CASE NUMBER | I-200-21267-604702 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-09-24 |
| DECISION DATE | 2021-10-01 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | DENTAL SERVICES MANAGER |
| SOC CODE | 11-9111.00 |
| SOC TITLE | Medical and Health Services Managers |
| FULL TIME POSITION | True |
| 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 | LAKEWOOD FAMILY DENTAL OF ANDERSON PC |
| EMPLOYER ADDRESS1 | 1537 S. SCATTERFIELD ROAD |
| EMPLOYER ADDRESS2 | SUITE A |
| EMPLOYER CITY | ANDERSON |
| EMPLOYER STATE | IN |
| EMPLOYER POSTAL CODE | 46016 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 17656494995 |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | KAKOLLU |
| EMPLOYER POC FIRST NAME | SRINIVASULU |
| EMPLOYER POC JOB TITLE | DIRECTOR |
| EMPLOYER POC ADDRESS1 | 1537 S. SCATTERFIELD ROAD |
| EMPLOYER POC ADDRESS2 | SUITE A |
| EMPLOYER POC CITY | ANDERSON |
| EMPLOYER POC STATE | IN |
| EMPLOYER POC POSTAL CODE | 46016 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 17656494995 |
| EMPLOYER POC EMAIL | SKAKOLLU@LAKEWOOD-FAMILYDENTAL.COM |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | LEGO |
| AGENT ATTORNEY FIRST NAME | KELLIE |
| AGENT ATTORNEY MIDDLE NAME | NICOLE |
| AGENT ATTORNEY ADDRESS1 | 10632 LITTLE PATUXENT PARKWAY |
| AGENT ATTORNEY ADDRESS2 | SUITE 406 |
| AGENT ATTORNEY CITY | COLUMBIA |
| AGENT ATTORNEY STATE | MD |
| AGENT ATTORNEY POSTAL CODE | 21044 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 12403900600 |
| AGENT ATTORNEY EMAIL ADDRESS | KELLIE@MVPLG.COM |
| LAWFIRM NAME BUSINESS NAME | MVP LAW GROUP PA |
| STATE OF HIGHEST COURT | MD |
| NAME OF HIGHEST STATE COURT | COURT OF APPEALS |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 1537 S. SCATTERFIELD ROAD |
| WORKSITE ADDRESS2 | SUITE A |
| LCA CASE WORKLOC1 CITY | ANDERSON |
| WORKSITE COUNTY | MADISON |
| LCA CASE WORKLOC1 STATE | IN |
| WORKSITE POSTAL CODE | 46016 |
| LCA CASE WAGE RATE FROM | 67600 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 61506 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2021 - 6/30/2022 |
| TOTAL WORKSITE LOCATIONS | 7 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | LEGO |
| PREPARER FIRST NAME | KELLIE |
| PREPARER MIDDLE INITIAL | N |
| PREPARER BUSINESS NAME | MVP LAW GROUP PA |
| PREPARER EMAIL | KELLIE@MVPLG.COM |
