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Group dentistry is constantly changing and evolving. There isn’t just one path to success. While private equity and the dental industry may be focused on large DSOs, smaller, but equally important emerging groups are quietly changing the landscape of dentistry.
All DSOs by definition provide non-clinical support services to affiliate dental practices, so they can in turn provide quality care to patients, while giving dentists autonomy and affording economies of scale. In order to eliminate redundancy, these common denominators are to be assumed for all groups below.
Here is Group Dentistry Now’s much-anticipated list of emerging dental groups to watch in 2020 (in alphabetical order):
Acorn Dentistry for Kids, a pediatric dentistry group in Oregon, is very much a “start a business in your parent’s garage” type story. In 2017, Dr. Tim Richardson and his team opened the first clinic in the house where two of the team members grew up. They centralized services in the unfinished basement of their first clinic. There was no heating system present, other than portable space heaters, in that basement.
A home-grown small town group, they are creating waves in Oregon. In less than three years, they have grown from zero to four clinics, with a fifth one opening this Spring. Their growth rate was a 50% increase from year one to two, and 60% from year two to three. They did not use private equity. What they did use was creative financing, bootstrapping, and reinvesting.
This DSO is 100% owned by dentists who actively practice in the organization. All decisions are made with patient care in mind as top priority. This is a high-performing group that calibrates as a team to provide the best patient care and the best team experience possible. It allows individual flexibility on work-life balance as well as a great income, while getting to be part of an incredible team that is young and hungry.
Acorn’s initial goal was seven to ten clinics in the first five years due to the need observed in their geographic area. They are on track to achieve that goal. Their de novo clinics are all located in Oregon: Silverton, Keizer, Corvallis, Hillsboro, and West Salem. They are however, open to acquisitions in the future.
Their goals include implementing solutions to their tension points, allowing all the new clinics to mature, and continuing to look for opportunities for additional clinics while attracting high-quality, low-ego doctor providers.
One of their core principles is a focus on individual growth and development. They start all new team members with a week of “Culture Club” where they talk very little about dentistry, focusing on their vision statement and ten core values, with videos, reading assignments, writing exercises, and a surprise all-day scavenger hunt around all the clinics. They also offer their team a paid day to read the book Leadership and Self Deception. Next is Training Week, followed by Integration Week. Rather than throw people in to sink or swim, they start people slow – including the doctors – so as to guide people into their roles.
Acorn operates without office managers and without lead dental assistants. Instead, they create leadership teams that share and rotate leadership roles so that everyone has the opportunity for personal growth and development. In this competitive market, they don’t have any problems hiring because many of their team members are referred by existing team members.
This unique group also has their own vocabulary:
- Instead of Call Center, they use P.E.A. Pod (Patient Experience Agents) because they are not simply taking and making calls – they are establishing a relationship with the person on the phone that sets them up for an amazing experience on site.
- Instead of Human Resources, they call it People Development because that is the focus – personal growth and development of each individual on the team.
- Words like ‘manager’ and ‘management’ are banned. Instead, they use ‘leader’ and ‘leadership.’ Their philosophy is that no one wakes up in the morning and says, “Manage me please,” but people do want to be led and have opportunities to lead themselves.
- They don’t use the word “staff,” because that is an infection (staph). They say “Team Members.”
- “Acoins” are wooden coins which can earned by team players. They can redeem Acoins for Acorn swag – shirts, pop-sockets, hydroflasks, etc.
The patient experience is largely driven by a focus on the team members who take care of the patients. Their tagline is “Growing Healthy Smiles” because they are not simply fixing and filling cavities. Their vision/mission statement has little to do with dentistry – dentistry is purely the vehicle that allows them to achieve their greater collective purpose.
Acorn believes every child deserves to grow up healthy and confident in the way they look and the way they feel. Treating children and families with respect, the team at Acorn empowers them to take control of their health. They do this by providing fast, quality dental care for kids in an environment of comfort and fun for the whole family. With a kid-friendly and aesthetically appealing decor, some patients ask if they can have their birthday parties in their clinics – which the group thinks is the ultimate compliment. Many of their online reviews also mention that their child keeps asking when they can go back to the dentist as soon as they leave.
A key success of the group is having a committed group of high-quality, low-ego doctors who care about the team just as much as the patients. They put people before profits, and the profits take care of themselves. The biggest business challenge of Acorn group is obtaining the financing to continue their growth and to add additional clinic locations.
Founded by Tim Richardson DDS, the group does not currently do not have any C-Suite Executives, but key team players are Dr Tess Gladstone, Dr. Jennifer Winslow, and Tara Nardin.
Founded by Marc Faber, Edge Dental Management started out as a single office in 2012 and has grown through the acquisition of under-performing practices. They currently have six greater New York area dental offices, each operating under its own name, and one admin space: Monroe, Pine Bush, Middletown, Newburgh, Poughkeepsie, Haverstraw, and Chester- Admin.
With a strategy of affiliation, the group’s mission is to use and empower the latest technology to provide their doctors and team members with an arsenal to provide the best clinical dental care. Not backed by PE, they are buying practices that nobody else wants, giving them the opportunity to provide excellent dental care to patients that may not have been given exceptional service in the past.
Edge Dental Management practices are the only offices in the area to offer Sunday appointments. Many patients find it difficult to schedule a dentist appointment around work, school and children, but with Sunday appointments they can give their patients the freedom to schedule a time that works best for them. If at this Sunday visit, they need a restoration, they can make the restoration right there in the office for the patient while they wait. Most patients will enjoy a cup of coffee and before they know if they are done and not in need of any additional visits.
Edge Dental Management’s goal for 2020 is to add a new location to the business, as well as complete construction on two sites, all while continuing to exceed patient care in their established growing practices. Their long term growth plan for the next five+ years is 20% growth year over year, while they continue to grow by seeking out one-two offices per year to develop into successful practices.
Respecting their patients’ time and understanding that multiple trips to the dentist may not be efficient for them, they use technology which offers same day treatment to all patients in all locations. That means their lab is in-office so they get to be hands-on in customizing each piece of lab work. Whichever treatment option the patient chooses, the group is confident that one of the doctors in the six practices can complete the treatment without having to refer out to a company with a different mission than theirs.
Their key successes are that their offices quickly become successful by using the latest technology and the passion their staff has to do dentistry.
Their biggest business challenge is that they have outgrown their office space because of rapid growth. Now they need to find space to better accommodate their growing group.
Key executives in group:
- Marc Faber, CEO
- Joseph Faber, Clinical Director
- Jeffrey Kay, COO
- Maury Goldsmith, CFO
Formed in Q4 2019 with operations in Texas and California, Endo1 Partners provides comprehensive knowledge, resources and shared back office support to endodontists across the country through an Endodontic Partnership Organization (“EPO”). Starting with six locations, they currently have eight locations, and will have 13 locations as of February 1, 2020.
Founded by Matthew Haddad, DMD, Daryl Dudum, DDS, Mark Haddad, DDS, Darron Rishwain, DDS, this private equity-backed DSO is majority owned and run by four endodontists. Only partnering with endodontists, they understand their specific needs. The group also provides specialized training, credentialing, marketing and cutting-edge equipment at the practice level specific to endodontics.
When endodontists join general DSOs, they are typically “on the road” providing services at various locations and don’t benefit from the comfort of having all their equipment in one place and enough patients in one location to fill their schedule. At Endo1, all they do is endodontics and they practice at one location with opportunity to buy into Endo1 after [2-3] years as associate.
As an EPO they are majority owned and run by endodontists, and thus cater to and understand their specific needs. As an EPO they only partner with endodontists which separates them from other DSO competitors that invest in general dental practices and other dental specialties, not specific to endodontics.
Having very limited competition since there are only a few endodontic-only DSOs in the US, Endo1 Partners encourages their sellers who express a desire to take their practice to the next level in terms of scale and growth, to retain some equity ownership (up to [25] %). Sellers can take some chips of the table today, continue to work in their own local practice, while receiving a second bite of the apple in a few years. By retaining equity in Endo1, they are all aligned to grow nationally.
Their goal for 2020 is to expand to 50 locations in multiple markets nationally. They are targeting 4-6% organic growth with their existing providers and ~20% organic growth by addition of new endodontists. They are planning on partnering with 25-35 endodontic practices per year. Their long-term growth plan for the next five+ years is continued expansion up to 200+ locations.
Endo1 Partners’ strategy is mostly acquisitions, however, they are open to build de novo as well on a case by case basis.
In the short time Endo1 has been operating, they have had tremendous interest and activity in potential partners. Thus their challenge is going to be properly navigating the pipeline and integrating the partners that best fit their vision and core values.
Key executives in group:
- Matthew Haddad, DMD, Co-CEO
- Daryl Dudum, DDS, Co-CEO
- Mark Haddad, DDS, Co-CCO
- Darron Rishwain, DDS, Co-CCO
- Meir Schwarzbaum, Chief Development Officer
- Silvestre Gonzalez, Vice President Operations
Founded in September, 2019 by Jeremy Lustig and Andrew Young, Five Point Dental Specialists has been moving quickly to grow via practice acquisition. Beginning with five orthodontic locations in the Dallas-Fort Worth area, they currently have ten locations in Dallas-Fort Worth and Southern Oklahoma. Backed by private equity, they have tripled revenue and EBITDA in the last 15 months.
Despite being primarily focused on partner affiliation and organic growth, they are employing de novo strategies as well.
Five Point Dental Specialists is a specialty-only group that is made up of orthodontic, oral surgery, and pediatric dental practices. They feel there is a definite synergy among these three specialties. Their business model includes creating geographic “pods” of these three specialties. All of their dentists, who are only orthodontists, oral surgeons, and pediatric dentists, are United States trained.
Five Point Dental Specialists forms a true economic partnership with the doctor to “maximize” the second sale opportunity, in addition to a healthy compensation when joining the group. The selling doctor maintains equity in his/her own practice in addition to the group. They also allow economic interests in other practices that are referred by the doctor and reward organic practice growth. They offer high, yet flexible compensation, including a fixed salary or % of collections. The dental group has a clinical advisory board that allows the dentist to have a voice in the direction of the group.
A key success of the group was their acquisition of six additional office locations in 2019, as well as the creation of a geographic “pod” of an orthodontist, three pediatric dentists and oral surgeon.
Their key business challenges have been integrating three different specialty practices and growing the group outside of DFW.
Five Point Dental Specialists’ 2020 goals include assimilation of their newly acquired orthodontic and oral surgery offices. In addition, they plan on starting a de novo oral surgery office and continuing their growth via acquisition of pediatric, orthodontic and oral surgery practices. With a five-year goal to expand their business footprint by partnering with industry leading doctors and executives to generate long-term sustainable growth, their growth goal is to reach a critical revenue that will be attractive to middle market private equity firms and to continue creating additional geographic pods in Texas and surrounding states.
Patient-centric from the moment patients step into the office, office tours are offered, along with spa-like amenities, digital radiography and imaging, flexible financing, and state of the art equipment and dental materials.
Key executives in group:
- Jeremy Lustig, CEO
- Andrew Young, CCO
- Zoe Johnson, CFO
What started as a note-sharing trip to meet a fellow YPO’er (Young Presidents’ Organization) with five dental practices, ended up organically becoming the soon-to-be formed Guardian Dentistry‘s first partnership & transaction. Thereafter, they established their partner-driven model and joined forces with four additional groups of passionate, purpose-driven dental entrepreneurs.
The group was founded by NKP Capital, which is the personal family office of Nayan Pathak (NKP are his initials). The group is not PE backed, but is dentist-entrepreneur and family-office backed.
In January 2019 they had zero practices, however their first partnership included five locations. Using five practices as their starting point, and now having 38 Locations throughout Detroit Metropolitan, Dallas Metropolitan, Eastern Pennsylvania, Northern Virginia, and North Carolina, at the end of Year 1 – their growth rate has been 600%. With a pure M&A strategy, a growth rate % is less meaningful to them. From an organic “same store sales” standpoint, they have experienced low-mid teen revenue growth, and 25-75 basis point margin expansion. From a M&A “inorganic” standpoint, they would like to acquire/affiliate 20 practices a year. Their strategy is affiliation/acquisition.
Guardian’s organizational structure is their key differentiator. Currently, they are a group DSO that consists of five key partnerships. They are investing behind proven dental entrepreneurs and forging such partnerships with leaders who want to continue to lead their group practice and continue to support the team that they have cultivated. They want to have their thumbprints on the growth of their business, as well as be able to continue to steer their business’ destiny and influence the direction that it grows in. They’ve built connections among their partners in different states/groups and have seen enthralling companionship manifest among the partners. While they are all like-minded in what they value, each of the partners are also very different, and it’s those very differences that make the group stronger when leveraged across the entire network of practices under their tutelage. There are many different roads to get to Rome, and similarly, there is no one way to build a successful group practice and they look forward to continuing to embrace those differences, while connecting the dots in the back-office.
Another key differentiator is that their partners are all meaningful stakeholders in their respective states at the DSO level, which strongly aligns interests as their partners will benefit from the DSO multiple and bespoke access to capital that NKP brings to the table; one of the most demonstrable phrases they say to their new partners to explain this concept is, “Our dollars are as green as yours” – a true partnership in every sense of the word. No disproportionate fees, no overly convoluted cap table – pari passu partners with meaningful voices at the table to deliberate and grow their business.
A reason an associate would want to work with their state partners – you are selling to a local partnership that consists of dentist owners/partners in key leadership positions, and with that you get a de-corporatized setting while still benefiting from economies of scale. Opposed to a highly corporatized setting, their partnerships are dynamic and flexible enough to accommodate any bespoke situation “transactionally” (all cash, equity, earn-outs, seller note, buy real estate, lease, etc) that is important to the seller and operationally (preserve brand, keep key roles, grow retained staff, slow or fast transition, etc) in a way that is the antithesis to the “one size fits all” merger & acquisition strategy and operational platform some of their competitors offer. Should a dentist want to step into a leadership role at the state partnership, Guardian can accommodate and that. Should a dentist want to relinquish all operational day-to-day tasks to their support team and just focus on patient care, Guardian can go in that direction. Priding themselves on being able to deliver highly customized transactions, integration, and operational experiences to their sellers, ultimately, they want to be stewards of a dentist’s business, embrace its identity, preserve what makes it special, and cautiously evolve with whatever participation level appeals to them.
The practices Guardian supports build lifelong relationships with their patients. Their dentists and their teams have been seeing their patients for years and over multiple generations. Not only do they focus on their overall oral well-being, but also on being part of the patients’ personal journey. They strive to celebrate patients’ milestones and achievements from births, graduations, weddings to career accomplishments and retirement. Their patients feel their genuine interest in where they vacationed, their New Year resolutions and their new challenges in life. Because of that relationship, they have always been generous in voicing their feedback and recommendations about the organization.
Guardian’s goals for 2020 include growing their marketing, HR and IT teams, establishing an educational/CE program, add 10-20 additional locations, and 2-3 new state partnerships.
Their long-term growth plan for the next five+ years is that they want to be able to serve their patients entire continuum of oral care by creating multi-specialty centers (the “Cleveland Clinic Model”) within their groups where internal referrals are sent to a skilled in-house specialists who provides the convenience of a ‘One Stop Shop’ to their patients, instead of being referred out. They also want to be the employer of choice for associates and employees, providing them with high-impact, career-changing educational and training resources, as well as world-class competitive benefits including a compelling equity program. From a size standpoint, they want to support 150-250 practices across eight-12 state/regional partnerships.
The model they developed to partner with dental entrepreneurs has proven to be a key success for the group and far more successful and be far more appealing than they could have ever imagined. They have been very fortunate to continue to receive a lot of inbound interest from dentists curious, but reserved, about joining a group. Dentists are seeing changes in the healthcare marketplace, advents in digital dentistry, declining PPO fees, and increased competition which all combine/compound in such a way that makes it difficult to maintain their profitability without working harder/longer. By promoting a culture that allows for not only employee-empowerment but doctor-partner empowerment, Guardian is able to bring together the best practices of several entrepreneurs and DSOs and merge them together, pick and choose what they all like and find consensus in, and build a unique DSO that is a merger of the best ideas and practices with a focus on locally-run, and locally-managed, support teams. Culturally, they believe that unwavering ethics and integrity are the hallmarks of their success.
With a dynamic team, their biggest challenge is managing the number of new ideas. They are continuously having to meter the ideas to focus on. The group leaders are fans of Jim Collin’s “Good to Great” book where he outlines the Hedgehog Concept, which is operating in a zone of genius derived from the intersection of (1) what you are deeply passionate about, (2) what you can be the best in the world at, (3) what best drives your economic or resource engine. Guardian continually try to pass many decisions through that intersection which they feel helps minimize the distraction.
The other main challenge they could face, which is more bespoke to them, is that given the number of leaders in the group, they could be exposed to a “too many cooks in the kitchen” situation where everyone is trying to drive the boat, but all are rowing in slightly different directions, and therefore they don’t end up moving any particular way. To combat that, they will get buy-in on their vision/mission/core values and then build-out a robust role-responsibility-function chart from bottom-to-top. They want to create a debate-deliberate-consensus culture where they will debate and deliberate ideas, and hopefully the solutions become so obvious, they achieve consensus. In the rare cases where they cannot achieve consensus on a topic, they will be comfortable with non-conformity (different labs, suppliers, PMS, etc), so long as the results and outcomes maintain standards of excellence.
Key executives in group:
- Drs. Hisham Barakat, Sanae Berrada, and Uzma Ansari: VA Partners
- Drs. Noah Levi & Oleg Krivichkin: MI Partners
- Dr. Antonio Molina: TX Partner
- TBA 2020: NC Partners
- TBA 2020: CMO/ COO
- Danny Kawas: Managing Partner
Their growth strategy for Nüva Smile is acquisition, affiliation, and de novo. Their mission is to provide affordable, quality care to patients while participating in community outreach within the areas they service. A doctor-owned and operated DSO, their goal for 2020 is to add $5 million in revenue through acquisition and organic growth.
Long term growth plan for the next five+ years are to continue to:
- build relationships within the dental community
- transition practices to strengthen the overall brand
- grow in areas where they feel the demographic of the patient they serve is best suited
- provide dentists full autonomy and tools to deliver the best care available.
When affiliating with a dentist, Nüva Smile understands and respects that doctors know their patients best, and their goal is to transition the patients and the dentist in the smoothest way possible. They achieve this by allowing the practitioner to dictate their own perspective and migrate from their practice at their own pace.
Having a diverse group of providers and employees which tends to mirror the community demographics, Nüva Smile’s patients are greeted with a smile by a team who is familiar with their care, history, and families. It is standard for their team members to greet patients by name and inquire about recent life events.
Not backed by PE at this time, they look to grow organically 7-10% per year through:
- internal marketing
- loyalty plans
- integrating new technologies
- growing the management team
- creating strong SOPs
- economy of scale.
Nüva Smile’s key successes include having implemented a dental operating system that is fully integrated across brands which has supported the creation of a centralized insurance billing and collections department. In doing so, the teams at the office are completely patient focused. They have also onboarded specialists within the practices in order to care for the entire family’s needs.
Thus far, the biggest business challenges for the group have been the perception of the DSO model as a clinic and the increasing competition for employees/providers as the DSO model continues to grow in NY and NJ.
Key executives in group:
- Dr. Mouner Amer, Chief Executive Officer
- Dr. Khaled Eldin, Chief Dental Officer
- Chick Hoff, Chief Operating Officer
Founded in 2011 with one practice by Dr. Jonathan Wong, the specialty group, Renovo Endodontic Studio and Water Tower Endodontics, is based in Illinois and headquartered in Schaumburg. The group has six locations (100+ mile geographic coverage) in the Chicago metropolitan area located in Schaumburg, Elgin, Rockford, Downers Grove, Roscoe Village and Water Tower – Chicago. Their strategy is accretive and/or dilutive acquisitions should the latter provide strategic value and potentially lead to a sufficient increase in earnings per share in later years.
The group, which is not back by private equity and is privately owned, has a growth rate 10.45% of net income. They have a target growth rate of 10-15% per year, whether through top line and/or bottom line growth. Embracing the age of digital transformation using technology, they engage their patients both online and in-person.
Their vision is to establish Renovo Endodontic Studio as the leader in specialized dental services, maintaining their uncompromising principles while they grow. Their mission is to be their patients’ most trusted dental specialists and to maintain oral health through exceptional people and technology.
Committed to a distinctive culture and core values that guide every interaction with patients, partners, and each other, Renovo Endodontic Studio believes their people are their most valuable asset. These values are reflected in their Code of Business Conduct and Ethics which emphasize placing the patients’ interests first, integrity, expertise, and commitment to innovation and excellence, and teamwork.
Recognizing, valuing, understanding and celebrating diversity, in patients, employees and communities, distinguishes them in the marketplace. They work with a spirit of collaboration that builds deeper relationships with patients, employees and communities.
Their goal for 2020 is to continue efforts to strengthen the organization and position themselves for future opportunities. Their long-term growth plan for the next five+ years is to be one of the only endodontist-run entities with the ability to expand an additional location organically every two years. This will allow them to provide systemized endodontic care to the standard of endodontists, as opposed to being endodontists housed within a larger general practitioner entity. Their plans are not confined to the state, and they look to venture beyond their boundaries to duplicate their systems with other willing endodontists.
Renovo Endodontic Studio and Water Tower Endodontics’ key successes include recent milestones:
- acquired their first growth by acquisition Q2 2017 – Water Tower Endodontics
- added Rockford location start-up Q3 2018
- renovated of Water Tower Endodontics Q1 2019
- expanded an existing location in Schaumburg and added four additional treatment rooms Q2 2019.
- streamlined internal processes, vendor procurement – cable and phone providers, clinical and office suppliers, print management services, merchant services, worker’s compensation policy, and marketing – that add more value and ensure that the service providers align and deliver on business goals.
- improved talent management strategy and goal alignment to increase employee engagement and the bottom line.
As they continue to grow, their biggest challenge is not sacrificing the customer service and quality of care that’s currently consistent at all their locations.
Key executives in group:
- Jonathan Wong, Principal Partner
- Wenfei Wang, Partner
- Alan Commet, Partner
- Nathaniel Wong, Managing Director
- Sundeep Dhawan, Partner
Select Dental Management was founded in February of 2018 by two life-long friends, Elliot Zibel, former institutional investor and Dr. Jonathan Mason, a ‘Top 30 under 30’ dentist, with the goal of creating a differentiated support and affiliation model focused on attracting and retaining the highest quality clinical partners. They began with one location and currently have eight locations in Connecticut and New York. They will be closing in on ten locations by the end of Q1 2020. Their strategy is affiliation.
The combination of analytical skills (Zibel worked for over 15 years on Wall Street), clinical capabilities, and leadership skills has proven to be a highly potent combination. Practices acquired in Select’s first year of operation have grown revenue 77% and new patients 140% within 12 months post affiliation. Their total revenue growth for 2019 was revenue +400% vs 2018, and their same store practice growth was 70% in 2019. Select has received a minority equity investment, along with a substantial debt capital commitment, from a healthcare focused private equity firm to support future acquisitions.
The group believes that practices run by clinical owners provide better patient care and perform at a higher level vs employee operated practices. All clinical associates Select partners with will have the ability to become practice level owners over a clearly defined time period and are able to generate wealth over time as they work together to grow their practices. Additionally, all of their office team members have a bonus plan tied to overall practice performance. They believe incentives drive outcomes and they ensure that as the practices grow the entire practice team is rewarded.
They have an unwavering focus on continuous learning and improvement for all clinicians and team members, which has been a huge attraction for talented clinicians who want to grow. Associates are paired up day one with a hands-on mentor who creates a formal plan to help improve clinical skills over time. Those mentors often sit chairside with associates while they do their first implant, bone graft or apicoectomy. They have funded >100 hours of CE for several associates in their first year with Select (vs 60 required over three years in NY state).
The group’s philosophy:
• Commitment: Provide exceptional care and a “Wow” experience to their patients every time they interact
• Comprehensive: They provide comprehensive care, Dentistry is about more than just teeth
• Continuity: Develop lifelong patient and team relationships
• Cultivation: Mentorship, education and training to empower leaders at the practice level
• Community: Strong presence in the communities in which they are located
Goals for 2020:
• Complete platform infrastructure optimization
• Further strengthen clinician value proposition
• Add talent to senior management team
• Scale to 16 practices by year end (100% growth)
Long term growth plan for the next five+ years is that they see the opportunity to scale to 50 practices over the next five years in their target markets which have far lower DSO penetration rates vs national averages. While they focus primarily on single location affiliations, they are currently evaluating larger affiliation opportunities as well(3-10 practices). Their pipeline contains > 40 practices generating in excess of $60mm in revenue. The majority of opportunities are proprietary non-brokered transactions generated from referrals.
Key successes of Select Dental Management:
• 8 high quality affiliations in first 18 months of operation
• 77% revenue growth within 1st year of affiliation to date
• 140% growth in number of new patients within 1st year of affiliation to date
• 5 Star google rating with >500 total reviews
• NPS score of 87 vs industry of 10
• All affiliated practice owners are references to future affiliation prospects
• Recruited 8 new doctors (100% retention)
• Substantial investments and infrastructure
• Recruited and developed a strong management team
Business challenges of Select Dental Management:
• Doctor recruitment
• Lab partners
• Investing in central functions to keep up with growth
Key executives in group:
- Elliot Zibel- CEO
- Dr. Jonathan Mason- Chief Clinical Officer
- Carrie Botsford- Chief Operating Officer (Formerly responsible for 90 offices at Midwest Dental)
- Dr. Zachary Korwin- Regional Clinical Director
- Dr. Joshua Bronner- Regional Clinical Director
Smiles West Dental Management was founded by Dr. Barry Deirmenjian in 
1996 with one location. They currently have 16 locations throughout California. They plan on a healthy growth rate of approximately eight-ten locations annually, with a target of 50 locations by 2022 and 100 locations following thereafter.
A privately solo owned DSO self-funded by the CEO without any financial sponsors or PE backing, they are compassionate to the dental provider, while understanding the business necessities of the company, all the while providing multi specialty dental services to the community regardless of payor type or economic situation. Every patient is treated equally and every dental staff and doctor the same.
Smiles West’s goal is to create a healthy multi specialty dental opportunity for all communities through access and acceptance of all insurances, while providing an amazing and unique environment regardless of economic background. Their growth is a amalgamation of key acquisitions/mergers and strategic startups.
Their goals for 2020 include continued growth at their present 20% level, while also expanding their technological footprint and adding new opportunities for their dental providers through education.
Their long-term growth plan for the next 5+ years is continual growth throughout California, with penetration into neighboring states.
The key differentiator for this group is their compassionate reputation – which is exemplary – and their payor relationship which opens many doors for the team to grow and expand. Their philosophy is that everyone has the opportunity to succeed and be promoted.
In keeping with their compassionate reputation, they offer multi specialty and same day appointments and services to patients along with complimentary transportation for seniors or families who have challenges to receive services. They also serve the special needs pediatric community with full surgical opportunities.
Smiles West has a unique family and loving culture that breathes life into a business that would be otherwise stale and boring. All their dentists and team members share the founder’s exhuberance and lead-by-example mentality.
They count relationships with insurance companies, vendors, and the dental team’s buy-in of culture and patient-first philosophy as keys to their success.
A saturated environment in California with high tax rates, high construction and real estate rates, and difficult employment laws are what they consider to be their biggest business challenges. But they never allow challenges to block their vision or hinder Smiles West’s goals.
Key executives in group:
- Dr. Barry Deirmenjian, CEO
- Lisa Iskandar, VP
- Blanca Valdez, Financial Specialist
- Natalie Vasquez, Regional Operations
- Sandra Mendoza, Revenue Management
The TREC Dental Group was formed in 2015 when five very successful practices in Calgary, Alberta decided to form a partnership. In an effort to effect cohesiveness, they chose a name which is an acronym of their shared values of Teamwork, Respect, Exceptional Dentistry and Continuous Improvement.
In addition to their five core practices, TREC started in 2015 with ownership in two other clinics and a fully digital ceramic dental laboratory. Since then, TREC has grown to a total of 15 clinics in Calgary and surrounding communities. Plans for 2020 include building two more de novo clinics, as well as adding four specialty affiliated practices.
The main founder of TREC is Dr. Noor Jaffer who established the first core clinic in Calgary in 1981. When his son Dr. Jan Jaffer joined him in 2002 after graduating from the University of the Pacific in San Francisco, they started growing their locations.
TREC prides itself in being a values-based, socially conscious group of dental practices that believe in giving back to the community, both locally and internationally.
While 80% of their growth has been through building beautiful high-end de novo offices in suburban locations in the Calgary vicinity, they are always open to acquisition and affiliation opportunities. They are currently looking to affiliate with some specialist groups to allow for more timely care for their patients.
TREC’s goals for 2020 include opening three more de novo offices and creating a working affiliation with a group of speciality clinics. While TREC does not have a growth target for locations, it is well known in the Calgary region and will continue to welcome both de novo and other acquisition proposals. They have created a management team and reporting structure that is prepared to accomodate more growth.
The main key to their success is the close and cohesive relationship among the seven core founding partners who started TREC and are still wet-finger clinic leaders. Having been together for years, the team of dentists are still good friends and they are poised to welcome new practices and dentists as they foster a culture of camaraderie.
Three factors that TREC Dental prides themselves on are:
- They are a dentist-owned and dentist-run middle-market DSO in Canada.
- When a practice is part of the TREC organization, there is no corporate feel to the operations. It still operates as an individual family practice with a resident owner.
- There is an ethos of giving back where all team members are given the opportunity to volunteer their time and talents to make our world a better place.
They also pride themselves in their new patient experience, which is quite unique. They have the ability to accommodate most patients’ schedules, while also adhering to the fee guide set by the dental college.
Not backed by PE, they are very well financed. The dental group is small enough to move quickly and nimble enough to close on opportunities if they are looking for a fair value with a reasonable transition arrangement.
The biggest business challenge facing TREC is finding good de novo locations or acquisition opportunities and experienced dentists that buy into their strong ethos of social consciousness.
Key executives in the group:
- Dr. Jan Jaffer CEO
- Nitin Khandekar COO
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