Dentists DSO-affiliated
16%
ADA HPI, 2024
Recent grads DSO-affiliated
27%
5 years or less out (ADA News)
Private sale basis
70-85%
of collections, most sales (DDSmatch)
DSO add-on
5-8x
EBITDA (FOCUS IB)
Side by side
| Private dentist buyer | DSO | |
|---|---|---|
| How price is set | % of collections, checked against loan capacity | Multiple of adjusted EBITDA after a market clinical wage for you |
| Cash at close | Most of the price (practice loan) | Majority, with 10-30% often rolled into DSO equity |
| Your role after | Short transition, often months | Employment agreement, commonly several years |
| Clinical control | Buyer's own | You practice; the DSO runs non-clinical operations |
| Upside | None after close | Rollover equity pays if the DSO is sold at a higher value |
| Best fit | Owner ready to stop soon, single-doctor office | Owner willing to keep producing; larger multi-doctor office |
Dollar example: same practice, two offers (fictional)
Collections $1,600,000. Owner SDE $520,000. DSO normalizes EBITDA to $300,000 after paying the owner a market clinical wage.
| Private dentist (78% of collections) | DSO (6.5x adj. EBITDA) | |
|---|---|---|
| Headline price | $1,248,000 | $1,950,000 |
| Cash at close | $1,248,000 | $1,462,500 (75%) |
| Rollover equity | - | $487,500 (25%) |
| Your income after close | None after transition | Clinical wage for the employment term |
| Guaranteed cash | $1,248,000 | $1,462,500 |
What trips owners up
- The EBITDA haircut. The DSO deducts a market wage for your dentistry before applying the multiple. Ask for their normalization schedule line by line.
- Rollover terms. Ask what the equity is priced at, what rights it has, and what happens if you leave early.
- Non-compete and clawbacks. Employment agreements often carry production targets and repayment provisions.
- DEA and credentialing. Your DEA registration does not transfer (21 CFR 1301.52); payer credentialing must be redone for the new owner.
- Corporate practice rules vary by state and shape how the DSO deal is structured. See selling a dental practice.
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Frequently asked questions
Do DSOs pay more than dentists?
Often on headline price, not always in guaranteed cash. Compare cash at close, the value and liquidity of rollover equity, and how long you must work.
What percentage of dentists work for DSOs?
The ADA Health Policy Institute reports 16% in 2024, up from 13% in 2022 and 8.8% in 2017.
Who are the largest DSOs buying practices?
See our list of DSOs buying practices, built from their own announcements.
Sources
- ADA Health Policy Institute - Dental practice research (accessed 2026-09-23)
- ADA News - Practice modality by the numbers (HPI data) (accessed 2026-09-23)
- FOCUS Investment Banking - Dental practice EBITDA multiples 2026 (accessed 2026-09-23)
- DDSmatch - How to value a dental office before selling (2025-06) (accessed 2026-09-23)
- BizBuySell Valuation Benchmarks - Dental Practice (accessed 2026-09-23)
- 21 CFR 1301.52 - DEA registration transfer rules (eCFR) (accessed 2026-09-23)