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How should DSOs plan acquisitions and de novo openings?

Among firms that serve dental practices, DSOs plan growth by weighing acquisition supply against de novo sites, and the supply is shifting: 16.1% of U.S. dentists were DSO-affiliated in 2024, according to the ADA Health Policy Institute, while 7,443 dental shortage-area designations were open as of December 31, 2025, according to HRSA via KFF. Neither figure picks a site; both frame where to look.

By DDSIntel Editorial· Published · Data as of

Key numbers

How much of dentistry is DSO-affiliated?

The ADA Health Policy Institute put DSO affiliation at 16.1% of U.S. dentists in 2024. Broader consolidation estimates run higher because they measure different things. DSOs planning growth should know which measure a figure uses before comparing markets. See how consolidated dentistry is.

When does a DSO choose acquisition over a de novo?

Acquisition buys an existing patient base and team, and a de novo builds a site from nothing in a chosen location. The choice depends on where sellers exist, where shortage areas are, and how quickly a site must produce. Retirement supply argues for acquisition; underserved areas argue for building. See DSO de novo site selection.

Seller supply is sized in dentist retirement statistics, and facilities signals show new-location activity in public records.

How should a DSO enter a new state?

Start with the state’s own licensing and entity rules, since practice ownership, supervision and corporate rules differ across states, and have counsel confirm them. Then compare dentist counts and shortage designations on equal terms. The dentists by state page lists every state’s cited figures side by side.

The DSO landscape explains how consolidation is measured.

What do vendors expect when a practice joins a DSO?

Labs, equipment suppliers and IT firms often find purchasing moves to a central team after an acquisition. A DSO that plans vendor transitions early avoids service gaps for patients. See what a sale means for lab accounts and IT during a sale.

Frequently asked questions

What share of dentists work for DSOs?

The ADA Health Policy Institute reported 16.1% of U.S. dentists were DSO-affiliated in 2024. Other estimates use different definitions.

How many dental shortage areas are there?

HRSA data via KFF listed 7,443 dental care HPSA designations nationally as of December 31, 2025. See dental shortage areas.

Does a shortage area guarantee a viable de novo?

No. A designation signals unmet need, not payer mix, rent, hiring or competition. Those inputs must be checked site by site.

Does DDSIntel cover every state?

Public figures on the data hub cover every state on equal terms. DDSIntel’s own measures are published in aggregate by state and region once each release is signed off.

Sources

  1. ADA Health Policy Institute. The U.S. Dentist Workforce, 2025 update. ada.org.
  2. HRSA, via KFF State Health Facts. Dental Care Health Professional Shortage Areas (HPSAs), as of December 31, 2025. kff.org.
  3. ADA Health Policy Institute, via KFF State Health Facts. Professionally Active Dentists, 2024. kff.org.
  4. TUSK Practice Sales. TUSK Practice Sales Assesses the State of the Dental Industry in Its Q3 2026 Dental Market Report (July 10, 2026). pr.timesenterprise.com.

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