By Jason M. Gamble, Vice President, Business Development, Healthcare Business Banking at U.S. Bank
As a dental practice gains momentum, the next logical step is often expansion–adding practices or locations to build on growth and reach more patients. For dentists considering this move, careful preparation is essential before taking the leap into acquiring a second practice or more. Here are 4 key tips for dentists contemplating this next step:
- Build the Right Foundation
A strong foundation is essential before expanding beyond a single location. While a single-entity limited liability company (LLC) is common for new owners, multi-site operators typically require a holding-company structure with separate operating LLCs for each practice.
This structure improves liability protection, simplifies financial reporting, and creates cleaner separation for future acquisitions, partnerships, and potential recapitalization events.
In addition, operators need centralized systems–human resources, revenue cycle management, procurement, payroll, analytics–to create a repeatable, efficient model that can scale predictably. - Build Your Advisory Team
A dentist can’t scale a practice alone. Building a strong advisory team is critical. In addition to hiring and partnering with dentists who share the same clinical and business visions, here are 3 other critical team members you will need.
• Attorney: A healthcare attorney is essential when forming a holding company, drafting operating agreements, reviewing purchase agreements, ensuring compliance, and protecting the owner during acquisitions.
• CPA: A Certified Public Accountant experienced in dental group operations ensures accurate, timely financials, and properly adjusted EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization) calculations. Clean financial statements drive lending capacity and valuation.
• One lending partner: Many operators accumulate multiple lenders as they grow opportunistically. This creates conflicting liens, inconsistent terms, slower transactions, and complicated exit strategies. A single lending partner–aligned with the owner’s long-term strategy–provides transparency, speed, and scalable capital. - Understanding EBITDA: The Engine of Scaling
As a group expands, a practice’s EBITDA–not collections–becomes the defining financial metric. It reflects true operating performance, determines borrowing power, and drives valuation during recapitalization or sale.
Operators should monitor location-level EBITDA, consolidated EBITDA, and trends in margin compression or expansion. Lenders and buyers evaluate the stability and scalability of EBITDA more than any other indicator.
Groups that measure EBITDA monthly and make data-driven adjustments outperform those that rely on collections alone. - Establish a Repeatable Operating System
Scaling requires consistency. Emerging groups that grow successfully build a unified operating system that can be implemented across current and future locations.
This includes standardized clinical protocols, scheduling templates, fee structures, revenue cycle workflows, staff role definitions, and performance dashboards.
An integrated operational framework reduces variance, increases predictability, and improves EBITDA contribution across the group.
In summary, owners who scale intentionally–rather than opportunistically–achieve better profitability, stronger valuations, and more lender support. This includes building leadership teams early, centralizing administrative functions, monitoring financial performance rigorously, and partnering with one lender capable of matching their long-term growth trajectory.
With the right structure, partners, and financial strategy, scaling from one to 10 or even more locations becomes not only achievable but strategically sound.