Multi-Practice Ownership

Please note: This list is for your informational use and not intended to replace the advice of professional advisors and specialists, including, but not limited to, attorneys and certified public accountants.

General Requirements

  • DDS or DMD degree
  • Completion of a postdoctorate program in orthodontics
  • State dental license
  • Résumé/CV
  • Business and strategic plan
  • Funding
  • Practice locations
  • Practice sale, partnership, and/or associate agreements
  • Business accounts
  • Business permit
  • Employer identification number (EIN)
  • National provider identification (NPI)
  • Local occupancy, zoning, and building permits
  • Equipment and supplies
  • Hardware and software systems
  • Office policies and procedures
  • Regulatory compliance
  • Personnel
  • Insurance – malpractice, life, health, long-term disability, property, commercial general liability, practice interruption, office overhead expense, worker’s compensation


  • Locations may be built from scratch or acquired by purchasing or merging existing practices
  • May include associate, independent contractor, or partnership arrangements with orthodontists, general dentists, or other dental specialists

Financial Risk

  • High financial risk to invest in new locations and manage a growing business
  • High start-up/acquisition, overhead, and operating costs
  • Requires significant investment in technology, infrastructure, marketing, employee recruitment, training, etc.
  • Could take several years to establish
  • Financing may be necessary
  • Factors such as debt, credit history, experience, the financial strength of the practice purchase, and proof of collateral may affect the ability to obtain financing from a lending institution
  • May experience costly and time-consuming logistical challenges during growth period
  • Opportunity to expand patient base, reduce competition, offer a wider range of services and clinical hours, as well as increase production and net income
  • May gain a competitive advantage by centralizing non-clinical functions and cutting overhead costs through economies of scale

Income and Other Compensation

  • Variable income based on revenue, costs, and expenses
  • May receive base income plus all or a percentage of profits
  • Income potential is greater compared to solo or group practice ownership, associate, independent contractor, academic, and military opportunities
  • Responsible for benefits such as vacation and sick leave, health insurance, life insurance, disability, retirement plan, professional dues, continuing education reimbursement, liability and malpractice insurance, etc.
  • Responsible for payroll, income, sales, and property taxes

Practice Operations

  • Requires entrepreneurial, managerial and administrative responsibilities
  • May have full, equal, or partial autonomy and control over practice decisions
  • Must be able to balance patient care and business operations across two or more offices
  • Opportunity to hire staff to manage certain business functions and devote more time to patient care
  • Requires awareness and evaluation of market conditions and practice performance
  • Requires a strong emphasis on company culture, leadership, communication, centralization, standardization, consistency, and efficiency
  • May share the same patient base with another orthodontist and/or develop an in-house referral base with a general dentist or other dental specialist
  • Practice merges may be difficult due to differences in culture, quality, processes, and technology

Learning Development Opportunities

  • Opportunity to obtain and utilize clinical, technical and practice management skills
  • Responsible for seeking out learning and professional growth opportunities
  • May work closely with and learn from a colleague and/or experienced doctor

Legal Considerations

  • Must understand and comply with federal, state, and local business laws, regulations, and requirements related to office design, employment, office safety, patient treatment, collections, malpractice, marketing, antitrust, taxation, and more
  • Responsible for selecting a business structure and understanding how it affects day-to-day operations, taxes, and personal liability
  • Responsible for liability issues such as malpractice claims, customer injuries, and employee activities

Contractual Considerations

  • Will enter into several contracts including business loans, consulting agreements, purchase/lease agreements for real estate and equipment, dental provider agreements, employment and compensation agreements, and more
  • Will be responsible for complying with all contractual obligations

Work Life Considerations

  • Can be difficult to enter certain communities due to market conditions and/or availability of purchase opportunities
  • Will have flexibility to set work hours
  • Can be difficult to take extended time off
  • May initially require a high degree of time and effort, with increased flexibility over time

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