Expanding a dental practice can mean opening another office, partnering with a health system or safety-net provider, joining a shared-services group, or reaching patients through teledentistry. The right route depends on the target state, patient need, ownership structure, services, workforce, and payer mix. Before committing capital, compare the operating models and confirm that licensing, clinical workflows, and reimbursement work in the market you want to enter.
Define the market before choosing the expansion model
“New healthcare market” can mean a new geography, a new care setting, or a new way of delivering dental services. Those choices create different costs and obligations. A second physical office requires a local operating plan; a health-system relationship changes coordination and potentially employment; teledentistry adds technology and remote-care workflows but does not eliminate local licensing or follow-up needs.
Start by specifying the patient group and unmet need you intend to serve. Identify the geography, services, likely referral sources, payer mix, and whether patients can reach in-person care when needed. Then decide what you want to own or control and what you could provide through a partner. The American Dental Association’s overview of practice models describes several structures, but it does not establish that a structure is suitable or legally available in every state.
Compare the ways a dental practice can enter a market
| Model | How it is organized | Questions to resolve before committing |
|---|---|---|
| Another owner-operated location | A practice adds a physical site and operates it as part of its business. | Can the practice recruit and supervise staff, sustain local operations, and serve the expected patient base under the target state’s rules? |
| Dentist group or shared-services cooperative | Dentists may practice in a group; a shared-services arrangement can centralize nonclinical functions while dentist ownership remains in place. | Who controls clinical decisions and business functions? Which services are shared, and how are costs, responsibilities, and performance data allocated? |
| Medical-dental or health-system arrangement | A medical-dental model may combine physician and dentist practices, shared records, employment by a health system, or referral relationships. | How will records, referrals, staffing, privacy, and care coordination work? Which entity employs clinicians or controls each part of the operation? |
| Federally Qualified Health Center (FQHC) or other safety-net setting | FQHCs are part of the dental safety net and often operate as integrated medical facilities with a shared patient chart. | What role can the practice take, what services are needed locally, and how will the organization’s operating and patient-care model fit the proposed work? |
| Teledentistry or community-based reach | Remote encounters can extend access; they may operate alongside a local practice or partner rather than replace in-person care. | Which encounters can be handled remotely, who provides follow-up locally, and do state rules and payer terms support the intended workflow? |
Use the table to narrow the options, not to assume that one model is inherently more profitable. The ADA model overview describes arrangements and characteristics; it does not supply a broadly applicable cost, revenue, payback-period, or market-size estimate.
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Build a market-entry case from local evidence
Before signing a lease, buying equipment, or committing to a partnership, assemble a practice-specific view of demand, capacity, and cash flow. There is no universal financial forecast for dental-practice expansion: the result depends on the location, ownership arrangement, service mix, staffing, and payer assumptions.
- Estimate demand: Define the patient population and services to be served. Validate referral access, local alternatives, geography, and the practical barriers patients face in getting care.
- Map payer exposure: Determine which public programs and private plans matter in the target market, then verify their enrollment, coverage, billing, and payment terms for the services you intend to provide.
- Cost the operating model: Include the people, premises or partner services, technology, training, administration, and follow-up capacity the chosen model requires. Separate one-time setup needs from recurring operating obligations in your own forecast.
- Test capacity: Identify who will recruit, supervise, train, schedule, document, bill, and handle referrals. For a virtual service, consider whether current staff and systems can support it without disrupting existing care.
- Set measurable decision points: Choose indicators that fit the model, such as appointment access, service utilization, completed follow-up, claims outcomes, or staffing capacity. Establish who will collect and review the data before launch.
Use conservative assumptions and test what happens if patient volume, staffing, payer participation, or claim payment differs from the plan. A projection becomes useful only when its assumptions are tied to the specific market and can be checked against actual operating data.
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Check state licensing and scope before serving patients across borders
For telehealth across state lines, HHS describes possible pathways that may include a full license, a temporary-practice provision or reciprocity, a compact, or telehealth registration where available. That general healthcare overview is not a determination of dental eligibility. Confirm the dental-board rules, scope-of-practice limits, and requirements for each state where a patient is located before offering services there. Verify the patient’s location and obtain consent before the appointment, as HHS advises.
The ADA’s teledentistry policy, updated in 2020, states: “The delivery of services via teledentistry must comply with the state’s scope of practice laws, regulations or rules.” The policy also says teledentistry does not expand the permitted scope of auxiliary personnel. Remote care therefore cannot be used to bypass local limits on who may perform a task or what care may be delivered.
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Repair Windows errors before they cause bigger problemsFix Now →Fix the driver behind crashes, sound loss and screen glitchesFind Drivers →Compact participation is time-sensitive. An April 2026 ADA workforce article reported that 12 states had passed legislation to join the interstate dentist and dental hygienist licensure compact and another eight had legislation pending at that time. This is a dated legislative snapshot, not confirmation that the compact is currently available in a particular state or that a specific dentist qualifies. Check the compact and the relevant dental boards for current status and individual requirements.
Design teledentistry around clinical need and local follow-up
Teledentistry may use live video (synchronous care) or an asynchronous store-and-forward workflow. HHS’s oral-health implementation guide, last updated August 6, 2024, identifies secure video-conferencing software, suitable computer hardware, tablets or smartphones, handheld intraoral cameras, and EHR integration as possible technology considerations. These are options to evaluate, not a checklist requiring every practice to buy every item.
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The clinical threshold matters more than the device list. The ADA says a remote examination or intervention should be consistent with in-person care and use enough information to support diagnosis and treatment planning. The dentist remains responsible for care quality and documentation, should provide the patient with a service summary, and should know which local dental resources can handle follow-up. A handheld intraoral camera is one possible tool for capturing detailed images; whether it is useful depends on the service, image needs, workflow, system compatibility, and privacy controls.
Plan the end-to-end workflow, not just the video visit. HHS highlights connectivity, contingency planning, security controls, patient education, staff training, and integration with scheduling, follow-up, and billing. Decide how a patient will proceed if a connection fails, images are inadequate, an in-person examination is needed, or a referral cannot be completed locally.
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Verify reimbursement and Medicaid operations with each payer
Do not assume that a service is payable merely because it can be delivered remotely. HHS says Medicaid teledentistry policies vary by state and advises checking private-insurance policies with the patient’s insurer. For every target payer, verify applicable codes and modifiers, documentation standards, claim-submission rules, and how denials and claims will be tracked. HHS’s general reimbursement guide was last updated August 6, 2024; it is not a current determination of a particular state program or insurance contract.
The ADA’s policy calls for dental benefit plans and public and private payers to cover covered teledentistry services to the same extent and at the same level as in-person services when providers meet the policy’s conditions. That is the association’s policy position, not a uniform legal entitlement or a guarantee of payment under an individual program, plan, or contract.
Medicaid participation also takes enrollment and administrative work. An ADA summary published in June 2026 describes a two-year pilot launched in 2023 in Maryland, Nebraska, Ohio, Pennsylvania, Rhode Island, and South Dakota. Four of the six participating states increased dentist participation in Medicaid and expanded dental-service utilization. This result belongs to that pilot; it is not a forecast of what a different practice or state will achieve. The summary highlights enrollment assistance, outreach and education, simpler administration, stakeholder collaboration, and reliable data as implementation considerations, and says reimbursement increases should be paired with provider outreach and education.
Use a staged decision process before launch
- Define the patient need and target: Specify the geography or care setting, population, services, and access problem the expansion is intended to address.
- Select a candidate model: Compare a new site, group or shared-services structure, medical-dental or health-system relationship, safety-net partnership, and virtual delivery against ownership, clinical integration, workforce, market access, and administration.
- Confirm legal feasibility: Ask the dental board and relevant state authorities about licensure, scope, supervision, telehealth, and any requirements for the chosen ownership or employment arrangement.
- Validate payer and enrollment terms: Contact Medicaid and private payers directly about participation, covered services, billing, documentation, and claims procedures for the target market.
- Build the operating and financial plan: Cost the specific staffing, facilities or partner services, equipment, technology, administrative burden, and follow-up capacity; show which assumptions need validation.
- Launch with accountability: Assign owners for clinical quality, compliance, technology, billing, and performance data. Review the indicators selected for the business case and adjust the model when results diverge from its assumptions.
The sequence is deliberate: an attractive patient need does not make a model workable if licensure, local follow-up, staffing, or payment cannot be resolved. Treat those as launch conditions rather than post-opening cleanup.
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