--- title: "Dental Practice Ownership: Buy, Start, Sell or Join a DSO" description: "A plain guide to dental practice ownership paths: buy, start, value, sell, work as an associate or join a DSO, with ADA data and who to hire." url: https://joncopeland.multisites.ai/guides/dental-practice-ownership publisher: Copeland Consulting Services email: drcopeland@joncopelanddds.com contact: https://joncopeland.multisites.ai/contact --- # Dental practice ownership: buying, starting, valuing, selling, associates and DSOs Dentists reach ownership by starting a practice, buying one, buying in as a partner, or working as an associate or for a DSO first. ADA data show 73 percent of dentists owned a practice in 2023, down from 85 percent in 2005. Each path needs an attorney, a CPA and often a lender or broker. Complete guideUpdated October 26, 202610 min read 1. 1 ## Ownership is a longer road ADA data show 73 percent of dentists owned a practice in 2023, down from 85 percent in 2005. Newer graduates reach ownership later. 2. 2 ## Five main paths Start, buy, buy in, work as an associate, or practice with a DSO. Many dentists use more than one over a career. 3. 3 ## Contracts decide the outcome Pay terms, covenants, goodwill and employment status all sit in a written agreement that an attorney should review. 4. 4 ## Advisers are part of the plan Valuation, tax, financing and law each belong to a qualified professional. This guide explains the questions to bring them. This guide maps the main routes into and out of dental practice ownership. It explains how each route works, what the published data show and which questions to bring to your advisers. It is general education by Copeland Consulting Services. It is not legal, tax or financial advice. ## What are the ways to own, or not own, a dental practice? A dentist can start a practice, buy an existing one, buy in as a partner, work as an associate, or practice with a dental support organization (DSO). These paths are not exclusive. Many dentists use two or three over a career, and each one changes risk, control and income in different ways. Path What it means Main trade-off to weigh Start a practice Build a new office, often called a de novo practice Full control of design and culture, with no existing patients or cash flow at the start Buy a practice Take over an existing office through a practice acquisition Existing patients and systems, with purchase debt and inherited habits Buy in Purchase a share through a buy-in and sign a partnership agreement Shared risk and workload, with shared decisions Associate Work for an owner as an [associate dentist](https://joncopeland.multisites.ai/glossary/associate-dentist) Lower financial risk, with less control over fees, schedule and team DSO Practice with or sell to a [dental support organization](https://joncopeland.multisites.ai/glossary/dental-support-organization) Business support handled by others, with different clinical and financial terms The sections below take each decision in turn. Each links to a longer guide. ## Is dental practice ownership becoming less common? Yes, and it is arriving later. The ADA Health Policy Institute (HPI) reported in June 2025 that 73 percent of U.S. dentists were practice owners in 2023, down from 85 percent in 2005. The same brief found that the drop is mostly in early career. Once dentists reach about 15 years in practice, ownership rates look similar across generations. HPI also reported that ownership is a longer process for newer generations, particularly those who graduated since 2011. A related paper in the peer-reviewed literature found that higher dental insurance concentration was associated with a dentist’s decision not to own a practice. These are population averages. They do not predict what will happen to any one dentist. Three numbers help set the scene. All come from the sources linked at the end of this page. Measure Reported figure Source and year Dentists who own a practice 73 percent (85 percent in 2005) ADA HPI, data for 2023 Dentists affiliated with a DSO 13 percent in 2022 ADA News on HPI data, 2023 Dentists affiliated with private equity 12.8 percent in 2021 (6.6 percent in 2015) ADA News on HPI paper, 2024 Figures change every year. Check the linked pages for the newest release before you rely on a number. ## How does a dentist buy a practice? A buyer sets goals, finds a practice, signs a letter of intent, completes [due diligence](https://joncopeland.multisites.ai/glossary/due-diligence), arranges financing and closes with a written purchase agreement. The details belong in the full [guide to buying a dental practice](https://joncopeland.multisites.ai/guides/buying-a-dental-practice). This section covers the outline. A common sequence looks like this: 1. **Set the goals.** Decide the location, size, clinical style and the debt you can carry. 2. **Build the team.** Hire an attorney and a CPA who know dental sales. A lender and a practice broker may join. 3. **Find and screen practices.** Review the numbers a seller shares before you visit. 4. **Make an offer.** The offer is often framed in a letter of intent that sets the price basis and timeline. 5. **Do the due diligence.** Check financial statements, tax returns, staff contracts, equipment, the lease and compliance records. 6. **Arrange financing.** A lender sets the terms. 7. **Close and transition.** The agreement covers patient records, accounts receivable, staff and how patients are introduced to the new owner. For financing, the U.S. Small Business Administration (SBA) lists changes of ownership, complete or partial, among the permitted uses of its 7(a) loans. Applicants must be creditworthy and show a reasonable ability to repay. The SBA also says applicants work with a lender, not with the SBA, and that the lender helps decide which loan type fits. Terms vary by lender and borrower, so only a lender’s written quote shows what a loan would cost. ## What does it take to start a dental practice? Starting a practice means building patients, staff, systems and compliance from nothing, so planning matters more than speed. The [guide to starting a dental practice](https://joncopeland.multisites.ai/guides/starting-a-dental-practice) covers the steps. Here are the main parts. - **A business plan.** It states the market, the budget and how the office reaches its first break-even month. - **Funding and working capital.** A new office has costs before it has income. A lender and CPA can test how much cash the plan needs. See the glossary entry on working capital. - **Legal and licensing steps.** Entity setup, the lease, equipment contracts and state requirements need an attorney. The Missouri Dental Board publishes the state’s rules. - **Compliance.** OSHA, HIPAA and infection-control duties apply to dental offices. The compliance checklist guide on this site lists the official sources. - **Patient flow and systems.** The [dental practice management guide](https://joncopeland.multisites.ai/guides/dental-practice-management) covers scheduling, recall and money systems. Only a written budget from your own advisers can say what a practice start-up would cost for you. This site does not publish cost figures. ## How is a dental practice valued? Appraisers estimate value with one or more accepted methods and then adjust the earnings for the owner’s pay and one-time items. The full [guide to valuing a dental practice](https://joncopeland.multisites.ai/guides/valuing-a-dental-practice) explains the inputs. Here is the short version. Term Plain meaning Income approach Value based on the cash the practice is expected to earn Market approach Value based on what comparable practices sold for Cost approach Value based on the cost to rebuild or replace assets [EBITDA](https://joncopeland.multisites.ai/glossary/ebitda) Earnings before interest, taxes, depreciation and amortization, often adjusted [Goodwill](https://joncopeland.multisites.ai/glossary/goodwill) Value above the physical assets, tied to patients and reputation The ADA tells sellers to engage “a dental practice valuator to assist in developing an independent and objective assessment regarding the actual worth of the practice, the patient population, equipment and, if applicable, real estate.” It also suggests a valuator who specializes in dental practices. Rules of thumb for price circulate online, for example a single percentage of collections. No published standard backs them. Treat a quoted shortcut as a starting question for your valuator, not an answer. ## What should a seller plan for? A seller needs an exit plan, a team of advisers, clean records and a clear picture of the transition. The [guide to selling a dental practice](https://joncopeland.multisites.ai/guides/selling-a-dental-practice) has the longer checklist. The ADA publishes a tip sheet on the topic. The ADA suggests that sellers build a team that can include: - a dental practice valuator, - an attorney experienced in dental practice sales, - a certified accountant experienced in practice sales, - a financial adviser for the proceeds, and - a broker experienced in selling dental practices. The same ADA page lists records that buyers will ask for. These include financial statements, balance sheets, federal tax returns, staff employment contracts, an equipment inventory, lease documents, and patient data such as active patients, new patients per month, case acceptance, recall scheduling and collection rate. Contract points the ADA tells sellers to read closely include patient records and access to them, whether there are restrictive covenants, how goodwill transitions, tax consequences, collection of accounts receivable and who stays on the team. Each party should have an attorney review the contract of sale. How long a sale takes varies by market and by how prepared the seller is. See the post on how long a sale takes. Planning an exit is also a succession planning task. The glossary also explains a partial exit. ## What do dental associate contracts cover? An associate agreement sets pay, duties, status and what happens after the job ends. The [dental associate contracts guide](https://joncopeland.multisites.ai/guides/dental-associate-contracts) covers each term. Three points come up most. **Pay model.** The ADA lists four common models: straight salary, salary plus commission, straight commission and net profit. Pay that depends on production needs clear definitions. The ADA defines total production as the amount the office bills under its fee schedule, and adjusted production as what the office is contractually allowed to collect. The two can differ a lot when many patients are on discounted plans. Read the glossary entries on production-based pay and collections-based pay, and the post on [associate pay models](https://joncopeland.multisites.ai/blog/dental-associate-compensation-models). **Employee or independent contractor.** The ADA says associates are generally employees when the employer has the right to control how duties are performed. A contractor handles their own schedule, taxes and benefits. A wrong label can create tax and legal trouble for both sides, so the ADA advises having an attorney review the terms. See independent contractor and the post on employee or contractor status. **Restrictive covenants.** The ADA explains that a non-compete is a mechanism that purportedly prevents an employee from competing after employment ends, and that to be valid it will almost certainly be limited in time and geography. Whether a specific clause can be enforced is a legal question. Ask an attorney who practices in your state. Terms to know include the non-compete clause and the non-solicitation clause. The post on employment agreement provisions lists others. ## What is a DSO, and what does the data show? A DSO is an outside entity that manages some or all of a practice’s non-clinical work, such as billing, marketing and human resources. The ADA HPI uses that definition and notes that DSO status is about the business model, not the size or number of locations. A single-office practice can be DSO-affiliated. The full [DSO and private practice guide](https://joncopeland.multisites.ai/guides/dso-vs-private-practice-guide) compares the models. The data show growth, mostly among newer dentists: Finding Source 13 percent of dentists were DSO-affiliated in 2022, up from 10.4 percent in 2019 ADA News on HPI data, 2023 27 percent of dentists under 10 years out of school were DSO-affiliated in 2024, versus 9 percent of those more than 25 years out ADA HPI brief, 2025 Dentists affiliated with private equity rose from 6.6 percent in 2015 to 12.8 percent in 2021 ADA News on HPI paper, 2024 HPI describes its practice modality data as showing that affiliation with large groups and DSOs “continues to grow, especially among early career dentists.” Terms related to this topic include [private equity in dentistry](https://joncopeland.multisites.ai/glossary/private-equity-in-dentistry), management services organization and dental partnership organization. For plain facts on each, read the posts on what a DSO is, private equity findings and [DSO versus private practice data](https://joncopeland.multisites.ai/blog/dso-vs-private-practice-data). This page does not say which model is better. The answer depends on the dentist’s goals, the specific contract and the specific organization. A dentist weighing an offer should read the full agreement and compare terms such as pay, clinical decision rights, covenants and exit options. ## Who should be on the team for an ownership decision? Ownership decisions involve law, tax, credit and valuation, and each has its own professional. This site does not provide that advice. The roles below show who handles what. Professional What they usually handle Attorney Purchase and sale agreements, employment contracts, covenants, entity setup, lease review CPA Tax effects, financial statements, entity choice, the net result of a deal after taxes Lender Loan structure, credit terms and repayment schedule Valuator or appraiser An independent estimate of practice value Broker Marketing a practice, finding buyers or sellers, negotiation support Financial adviser Investing sale proceeds and long-term planning The ADA adds two practical tips. Contact your professional liability carrier to see if they have suggestions, and consult an attorney early so assets stay protected and state and federal laws are followed. The ADA’s own contract guide carries the same warning. In its disclaimer it says to get legal or professional advice, “you need to consult directly with a properly qualified attorney admitted to practice in your jurisdiction.” ## What should you read next? Match the next page to the decision you face. - Considering a purchase: [Buying a Dental Practice](https://joncopeland.multisites.ai/guides/buying-a-dental-practice). - Planning a new office: [Starting a Dental Practice](https://joncopeland.multisites.ai/guides/starting-a-dental-practice). - Needing a price estimate: [Valuing a Dental Practice](https://joncopeland.multisites.ai/guides/valuing-a-dental-practice). - Planning an exit: [Selling a Dental Practice](https://joncopeland.multisites.ai/guides/selling-a-dental-practice). - Reviewing an offer: [Dental Associate Contracts](https://joncopeland.multisites.ai/guides/dental-associate-contracts). - Comparing models: [DSO vs Private Practice](https://joncopeland.multisites.ai/guides/dso-vs-private-practice-guide). Money questions also lead to practice management. The [dental practice management pillar](https://joncopeland.multisites.ai/guides/dental-practice-management) covers overhead, collections and the other numbers every valuation looks at. For the numbers behind pay and profit, see the posts on overhead percentage and how much practice owners make. ## Next step For the numbers that sit behind any ownership decision, start with the [dental practice management pillar](https://joncopeland.multisites.ai/guides/dental-practice-management). To talk about a specific practice question, [contact Dr. Copeland about consulting](https://joncopeland.multisites.ai/contact?topic=consulting). Dr. Jon Copeland, DDS, is a general dentist in Wildwood, Missouri. ## Frequently asked questions ### Is owning a dental practice worth it? It depends on goals, debt, risk comfort and local market. ADA research shows most dentists eventually own: ownership was 73 percent in 2023, and late-career rates were similar across generations. Owners also carry staffing, debt and compliance duties. A CPA and lender can test the numbers for one specific practice. ### How do you buy a dental practice? The usual steps are to set goals, find a practice, sign a letter of intent, complete due diligence, arrange financing and close with a purchase agreement. An attorney, CPA, lender and often a broker help at each step. The buying guide on this site walks through the sequence. ### How do you calculate the value of a dental practice? Appraisers combine methods such as the income, market and asset approaches, and they adjust earnings for the owner and one-time items. No single formula fits every office. The ADA advises sellers to use an independent valuator and suggests one who works with dental practices. ### What is the difference between a DSO and a private practice? The ADA Health Policy Institute counts a practice as DSO-affiliated when an outside entity manages some or all of its non-clinical functions, such as billing, marketing and human resources. A private practice keeps those functions in-house. Size alone does not decide it. ### Should a dental associate be an employee or an independent contractor? The ADA says status depends on how much control the practice has over how and when you work, and on financial control. The agreement should state the status clearly. Because tax and employment law apply, have an attorney review the contract before signing. ### Who should help when buying or selling a practice? The ADA lists a dental practice valuator, an attorney, a CPA experienced in practice sales, a financial adviser and a broker. Lenders join when financing is involved. Each handles a different risk, and none of them replaces the others. ## Terms on this page - [Management services organization](https://joncopeland.multisites.ai/glossary/management-services-organization) - [Dental partnership organization](https://joncopeland.multisites.ai/glossary/dental-partnership-organization) - [Dental support organization](https://joncopeland.multisites.ai/glossary/dental-support-organization) - [Private equity in dentistry](https://joncopeland.multisites.ai/glossary/private-equity-in-dentistry) - [Dental practice management](https://joncopeland.multisites.ai/glossary/dental-practice-management) - [Non-solicitation clause](https://joncopeland.multisites.ai/glossary/non-solicitation-clause) - [Independent contractor](https://joncopeland.multisites.ai/glossary/independent-contractor) - [Collections-based pay](https://joncopeland.multisites.ai/glossary/collections-based-pay) - [Missouri Dental Board](https://joncopeland.multisites.ai/glossary/missouri-dental-board) - [Partnership agreement](https://joncopeland.multisites.ai/glossary/partnership-agreement) ## Sources 1. [ADA Health Policy Institute: Practice Ownership Trends in Dentistry, A New Look at Old Data (June 2025)](https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/practice_ownership_trends_dentistry_new_look_old_data.pdf) 2. [ADA: What to Do When Selling a Practice](https://www.ada.org/resources/practice/practice-management/what-to-do-when-selling-a-practice) 3. [ADA: Dentist compensation, what every dental associate should know](https://www.ada.org/resources/careers/dentist-compensation) 4. [ADA: Employee or independent contractor? Considerations for dentists](https://www.ada.org/resources/careers/employee-or-independent-contractor) 5. [ADA: Dental Employment Agreements guide to key legal provisions](https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/practice/legal-and-regulatory/guide-to-key-legal-provisions.pdf) 6. [ADA News: More dentists affiliating with DSOs (June 2023)](https://adanews.ada.org/ada-news/2023/june/more-dentists-affiliating-with-dsos/) 7. [ADA News: Private equity affiliation among dentists increases (August 2024)](https://adanews.ada.org/ada-news/2024/august/private-equity-affiliation-among-dentists-increases/) 8. [ADA Health Policy Institute: Practice Modalities Among U.S. Dentists](https://www.ada.org/resources/research/health-policy-institute/dental-practice-research/practice-modalities-among-us-dentists) 9. [U.S. Small Business Administration: 7(a) loans](https://www.sba.gov/funding-programs/loans/7a-loans) 10. [Health Economics Review via PMC: Consolidation in the dental industry, a closer look at dental payers and providers](https://pmc.ncbi.nlm.nih.gov/articles/PMC7326818/) Written by Copeland Consulting Services and checked against the sources above on October 26, 2026. Rules, data and guidance change, so check the linked page before you act on it. ## Keep reading - [DSOs and private practice: models, data and questions to askA dental support organization (DSO) manages some or all of a practice's nonclinical work, such as billing, marketing and human resources. ADA data show 16.1% of U.S. dentists were DSO-affiliated in 2024, and 27% of those under 10 years out of school. Each model has trade-offs.](https://joncopeland.multisites.ai/guides/dso-vs-private-practice-guide) - [Selling a dental practice: timeline, taxes and transitionSelling a dental practice involves planning, a team of advisers, organized records, a contract, tax reporting and a patient transition. The ADA says a listing-to-closing timeframe of four to six weeks is a general rule of thumb, though real deals vary. Start early and involve an attorney and a CPA. This is education, not advice.](https://joncopeland.multisites.ai/guides/selling-a-dental-practice) - [Dental associate contracts: terms, pay models and red flags to ask aboutA dental associate contract sets pay, status, duties, term, termination, insurance and limits on work after you leave. The ADA publishes a guide to key provisions and a compensation explainer. Pay models differ in what they count, so read the formula. Have an attorney in your state review any contract before you sign.](https://joncopeland.multisites.ai/guides/dental-associate-contracts) - [Starting a dental practice: planning, funding and complianceStarting a dental practice means building the business from nothing: a plan, a startup cost list, funding from a lender, a licensed entity, a site, equipment, a team and compliance systems. The SBA publishes free planning tools. Cost depends on your plan, so get quotes. This guide is education, not legal, tax or financial advice.](https://joncopeland.multisites.ai/guides/starting-a-dental-practice) - [Valuing a dental practice: methods, inputs and questions to askA dental practice is valued with a method, not a rule. The SBA lists five: capitalized earning, excess earning, cash flow, tangible assets, and specific intangible assets. Each needs records such as financial statements and tax returns. The result depends on the inputs and the person doing the work. Use an independent valuator.](https://joncopeland.multisites.ai/guides/valuing-a-dental-practice) - [Buying a dental practice: steps, financing and due diligenceBuying a dental practice usually runs in six stages: define your goals, get financing, value the practice, sign a letter of intent, complete due diligence, and close. Lenders, attorneys and accountants each own part of the work. This guide explains the steps and lists questions to ask. It is not legal, tax or financial advice.](https://joncopeland.multisites.ai/guides/buying-a-dental-practice) ## Talk with Dr. Copeland [Contact Dr. Copeland](https://joncopeland.multisites.ai/contact)[Email](mailto:drcopeland@joncopelanddds.com)