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What buyers look for in your dental practice

Jacob Lee · October 4, 2026 · 12 min read

Dentistry has become one of the most heavily consolidated corners of healthcare. As of mid-2025, roughly 130 private equity backed DSOs were operating in dental, more than in any other healthcare vertical. The share of dentists affiliated with private equity roughly doubled from 6.6% in 2015 to 12.8% in 2021, and DSO affiliation reached 16.1% of US dentists in 2024, more than double its 2015 level. Among dentists less than 10 years out of dental school, 27% are now DSO-affiliated, up from 24% a year earlier.

The buying isn't slowing down. Dental deal counts fell 37.2% in 2025, led by endodontics and periodontics, but buyers are gearing back up. In an April 2026 survey, 69% of DSOs said they expect to increase acquisitions this year, and 78% anticipate a recapitalization within 12 to 36 months. PE-backed DSOs continue to buy individual practices as tuck-in acquisitions, typically at 3x to 6x EBITDA.

At the same time, a generation of owners is heading for the exit. About a third of practicing dentists are over 55, and 26% are between 55 and 64. Nearly three in four dentists still own their practices, but younger dentists are buying later than earlier generations did, and today's owners are retiring later too. M&A advisors now describe the largest retirement-age group in the profession's history as approaching transition. Many of the practices that change hands over the next several years will belong to long-tenured owners who have never sold a business before.

The result is a market with more kinds of buyers than ever: individual dentists, small groups, regional DSOs, and private equity platforms, each measuring your practice with a different yardstick. But whoever is buying, the evaluation runs on the same fundamentals.

That's where we come in. We work with dental practice owners long before they sell, often years ahead, so that when the time comes, they're ready. We've worked in M&A and sat on the private equity side of the table as buyers, so we know how buyers think and what they're really looking for, including the things you won't find online. This guide walks through what prepared buyers check, so you can fix what's fixable, document what's strong, and maximize the value of what you've built.

1. Whether your documents are ready on day one

Serious buyers ask for six things before they evaluate a single number:

  1. Broker packet or practice overview (address, asking price, operatories, square footage)
  2. Production by procedure report for a full year, with ADA codes, counts, and revenue
  3. Profit and loss statement for the most recent full year, ideally two
  4. Staffing breakdown: hygienists, assistants, front desk, associates
  5. Insurance mix: % PPO, fee-for-service, Medicaid, HMO
  6. Rent or real estate details

Well-advised buyers are told to walk away if a broker asks for an offer before sharing these. Having them clean and ready signals a transparent seller and speeds up every step after.

Seller tip: Pull your production by procedure report now. It's the document buyers trust most, because it shows what you actually do clinically, not just what you collected.

2. The real size of your patient base

To a buyer, the patient base is the asset. And they won't take your active patient count at face value, because broker counts are almost always inflated.

Instead, they'll estimate it two ways:

  • The D0120 method: periodic exams in the last 12 months divided by 1.5. For example, 2,400 exams ÷ 1.5 is about 1,600 active recall patients.
  • The hygienist check: roughly 800 active patients per full-time hygienist.

If you claim 2,000 patients with one hygienist, a buyer will notice the gap and trust the rest of your numbers less.

Active recall patients How buyers see it
Under 1,000 Below solo threshold, needs growth investment
1,000 to 1,600 Solo practice, the sweet spot for a single-doctor buyer
1,600 to 2,200 Busy solo, room to add an associate
2,200+ Group practice, supports multiple providers

Seller tip: Use the buyer's math in your own listing. An honest, defensible patient count builds more trust than a big one.

3. Production per patient and repeatability

Buyers divide annual collections by active recall patients. Counterintuitively, lower is often more attractive to them. Below about $900 per patient suggests untreated dentistry a new owner can capture.

A high number makes buyers ask whether your production is repeatable. Benchmarked against hundreds of practices, the average practice performs about 251 crowns and 711 fillings per 1,000 recall patients. If your crown volume is several times that, expect a buyer to pull X-rays and question whether the treatment was clinically justified.

What this means for you: a practice that's been coasting isn't necessarily a weak sale. Buyers looking for growth may see untreated need as upside. A practice that looks extremely productive per patient may face more scrutiny, not less.

4. How dependent the practice is on you

This is one of the biggest value drivers, and one of the most overlooked by sellers. Buyers ask: if the owner walks out, how much revenue walks out too?

They'll look for:

  • Procedures only you perform. If $220,000 a year comes from endo and implants the buyer can't do, they'll subtract it. In one evaluation, a practice listed at $1.1M collecting $1.4M was adjusted to $860,000 for exactly this reason.
  • Referral relationships tied to you personally. Referrals that follow you, not the practice, don't transfer.
  • Patients loyal to you by name. Expect buyers to ask for a transition period where you introduce them.
  • Your hours. If you work five long days and the buyer plans to work four, your production may not be replicable.

On the other hand, if you refer out endo, implants, and perio, buyers see $60,000+ a year they can potentially bring in-house. That's a selling point.

Seller tip: In the years before a sale, consider bringing on an associate, documenting systems, and letting your team handle more of the patient relationship. A practice that runs without you is worth more.

5. Your insurance mix

Two practices with identical revenue can deliver very different owner income depending on who's paying. PPO-heavy practices typically collect 60 to 70% of billed production, while fee-for-service practices collect closer to 90 to 95%. That gap can swing take-home pay by $100,000+ a year.

Buyers will also ask whether your PPO contracts transfer, and how many fee-for-service patients are loyal to you rather than the practice.

6. Overhead, space, and the condition of the office

Buyers benchmark your overhead line by line:

Metric What buyers want to see Red flag
Rent as % of collections Under 7% Above 10%
Production per operatory Median about $188,000/year Below $100,000/year
Operatories 6 to 10 Too few to grow into
Equipment age Updated within 10 years 10+ years old, $50K to $150K in upgrades

They'll also check lease terms (years remaining, renewal options, escalation clauses) and staff tenure. Losing a long-term hygienist or office manager after a sale can cost months of momentum, so a stable team adds value.

Seller tip: Secure lease renewal options before you list, and fix deferred equipment issues if the cost is modest. Buyers will deduct more for an old compressor than it costs you to replace it.

7. Market density and location

Buyers look at more than your four walls. They want to know whether the market can support the practice under new ownership.

  • Dentist-to-population ratio. Fewer dentists per resident usually means easier patient growth. Saturated urban areas can mean more competition for every new patient.
  • Population and income trends. A growing, stable, or aging community each points to different demand.
  • Nearby competition. New DSO offices or corporate practices opening nearby will come up.
  • Rural vs. urban pricing. A practice priced at 95% of revenue in a rural market is a different deal than one at 95% in Manhattan, because fees, rent, and staffing costs differ.

Rural practices often face a smaller buyer pool, but they can also offer buyers less competition and a strong patient base, which is worth highlighting.

8. Price: percent of collections vs. EBITDA multiple

How your practice is valued depends on who is buying.

Individual dentists typically think in percent of collections, then test it against affordability. Across the practices we see, the median asking price is around 83% of annual collections, with a range of 40% to 120%. Most banks won't lend more than about 100% of annual revenue, and prepared buyers want their loan payment under about 12% of revenue so there's enough left for take-home pay.

DSOs and private equity groups usually value practices on a multiple of adjusted EBITDA (earnings before interest, taxes, depreciation, and amortization). That means your profit, after normalizing the books, matters more than your top-line revenue. Multiples vary widely by deal size, specialty mix, location, and how much the practice depends on the owner. Larger multi-doctor practices generally command higher multiples than single-doctor offices. These deals also often include equity rollover, earnouts, or a required work-back period, so compare total terms, not just the headline number.

Normalizing your EBITDA: buyers will add back personal expenses run through the practice (car leases, family on payroll, travel) and replace your owner compensation with what an associate would cost. Cleaner books mean a cleaner, more defensible number.

This section is general education, not valuation, tax, or legal advice. Talk with your CPA and transition attorney about your situation.

9. What kind of seller you are

Buyers evaluate you, not just your numbers. Most sellers fall somewhere between two types.

The emotional seller built the practice over decades, and it shows. Price is anchored to what the practice means to them. Questions about the numbers can feel personal, and they may resist due diligence or slow down the process. Buyers often see this as transition risk, and some will move on to an easier deal.

The numbers-driven seller prices from data, shares documents quickly, and expects negotiation. Buyers find them easier to work with, and deals tend to close faster and with fewer surprises.

Being proud of your practice isn't a problem. Buyers simply value sellers who can separate the legacy from the transaction. Some practical ways to be the seller buyers want:

  • Price from the buyer's metrics, not from what you need for retirement.
  • Share the six core documents promptly and completely.
  • Be honest about why you're selling and whether you plan to stay in the area. Buyers ask, because "retiring" sellers who stay local sometimes take patients with them.
  • Decide in advance how long you're willing to stay on after the sale, and say so.
  • Expect questions about your clinical style and treatment planning, and answer them openly.

Pre-sale checklist

  • Production by procedure report for the last 12 months pulled and reviewed
  • Two years of P&Ls with add-backs identified
  • Active patient count calculated using the D0120 method
  • Staffing list with roles, hours, and tenure
  • Insurance mix by revenue and list of PPO contracts
  • Lease reviewed, renewal options secured
  • Equipment list with ages and any planned replacements
  • Clear answer on your post-sale plans and transition period

Frequently Asked Questions

What do buyers look for when buying a dental practice?

A real, verifiable patient base, repeatable production, sustainable overhead, a favorable insurance mix, limited dependence on the selling dentist, a healthy local market, and a transparent seller.

How are dental practices valued?

Individual buyers usually think in percent of collections, where the median asking price sits around 83%. DSOs and private equity groups usually use a multiple of adjusted EBITDA.

How can I increase the value of my dental practice before selling?

Reduce dependence on yourself, clean up your books, secure your lease, keep your team stable, and have your documents ready before you list.

Most of this is fixable, with enough runway

Owner dependency, overhead, a lease, the state of your books: each one moves the number, and each takes time. We work with owners years before a sale so the practice is ready when the offer comes.

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