What's Your Practice Worth? It Depends on Who's Buying.

Here's the answer up front: your practice doesn't have one value. It has at least two, and the gap between them can run into the hundreds of thousands of dollars. Sell to another dentist and you'll typically get 60 to 85% of collections, or roughly 1.5 to 2.5 times seller's discretionary earnings. Sell to a DSO or private equity group and the same four operatories get priced on a multiple of adjusted EBITDA, anywhere from 5 to 8x for an add-on acquisition up to 10 to 12x or more for a platform-grade practice. Same chairs, same patients, same production. Materially different check.

If you're within five years of any transition, understanding both rulebooks isn't optional homework. It's the difference between negotiating and getting negotiated.

From the Practice Market Index: as of September 2026, the median dental practice listed for sale collects $957,588 a year, across 753 current listings. See the full index, updated weekly.

Two Buyers, Two Rulebooks

When a dentist buys your practice, they're buying a job plus a business. They care about whether the practice can service the acquisition loan while paying them a living wage from day one. That's why doctor-to-doctor deals anchor to a percentage of collections. The buyer's bank runs the numbers on cash flow after debt service, and everybody prices off that.

When a DSO buys your practice, they're buying a cash flow stream they can bolt onto a larger machine. They don't intend to drill teeth in your operatory, so they must pay someone else to do the clinical work. That single fact rewires the entire valuation. What matters to them is adjusted EBITDA: earnings before interest, taxes, depreciation and amortization, after normalizing your compensation to what they'd actually pay an associate to produce what you produce. TUSK Practice Sales walks through this exact adjustment: whatever you pay yourself above the market clinical rate gets added back to earnings, and whatever you underpay yourself gets subtracted. Then the buyer applies a multiple, and TUSK's own illustrative range runs from 5x for a single-doctor rural practice to 8.5x when a competitive sale process is run well.

Neither method is wrong. They're answering different questions. The dentist buyer asks "can I make a living here after the loan payment? The DSO asks "what does this cash flow look like when we own it and staff it? Your job as a seller is to know which question your practice answers better.

Why the Buyer Pool Is Shifting Under Your Feet

The reason this matters more every year is that the population of traditional buyers is thinning out. The ADA Health Policy Institute reports that 73% of U.S. dentists were practice owners as of 2023, down from 85% in 2005. That's twelve points of ownership appetite gone in less than two decades.

Look at where younger dentists are landing and the trend gets sharper. In 2024, 27% of dentists less than 10 years out of dental school were affiliated with a DSO, up from 24% just one year earlier. Among dentists who graduated more than 25 years ago, that figure is only 9%. The associates you're hoping will buy your practice in 2030 are, in growing numbers, already employed by the organizations you'd be competing against for their attention.

To be clear, this isn't a story about a shrinking profession. The Bureau of Labor Statistics counted 121,640 general dentists in national employment as of May 2023, with a mean annual wage of $191,750 and a median of $166,300, and projects overall dentist employment to grow 6% from 2025 to 2035, faster than the average for all occupations, with a median annual wage of $176,110 as of May 2025. There will be plenty of dentists. There will just be fewer of them who want to sign a seven-figure practice loan, and more institutional buyers with cheap capital who don't need one.

Fewer individual buyers plus more institutional buyers means the EBITDA rulebook is showing up in more of your exit scenarios whether you invited it or not.

Operator Math

Let's price the same practice both ways. Take a solo owner collecting $1.5 million a year, running a tight ship at 60% overhead before any doctor compensation. Operating expenses come to $900,000, leaving $600,000 of pre-owner-comp profit. That $600,000 is effectively the owner's total take: salary, distributions, the truck in the parking lot, all of it.

Route one: sell to another dentist. A healthy, transferable solo practice in a decent market might price at 75% of collections, which puts the sale at $1,125,000. Cross-check it against discretionary earnings: at 2.0x SDE, the middle of the 1.5 to 2.5x range US Dental Transitions cites for doctor-to-doctor sales, you'd get $1,200,000. The two methods land within shouting distance of each other, which is what you'd expect. Call it roughly $1.1 to $1.2 million, mostly cash at close, and you walk away clean.

Route two: sell to a DSO. Now we rebuild the profit line the way their analysts will. Say the owner personally produces $1.2 million of the $1.5 million in collections, with hygiene generating the rest. At a market associate rate of 30% of production, replacing the owner's hands costs $360,000 a year. Adjusted EBITDA is the $600,000 of pre-owner-comp profit minus that $360,000 replacement cost, or $240,000. At a 6x add-on multiple, squarely inside the 5 to 8x range for add-on acquisitions, the enterprise value comes to $1,440,000.

That's $315,000 more than the doctor-to-doctor price in this scenario. And if this practice were part of a multi-location group trading at a 10x regional or platform multiple, the same $240,000 of EBITDA would be worth $2,400,000. That's the arithmetic behind every group-formation pitch you've ever heard at a study club.

Before you call a broker, finish the math. DSO offers rarely arrive as 100% cash. If 70% comes at close and 30% rolls into equity or holdbacks, your wire on closing day is $1,008,000, which is less cash in hand than the doctor sale. Plus you're likely signing a three-to-five-year workback at that $360,000 associate rate instead of keeping the full $600,000 you used to pull out. That's $240,000 a year in forgone income for every year you stay. Over a four-year workback, the income you give up totals $960,000, which is most of the headline premium. The DSO deal can still win, especially if the rolled equity gets marked up in a recapitalization. But it wins on paper and over time, not in the closing wire. Run both columns to the end before you pick one.

What Moves You Up a Tier

The multiple tiers aren't a lottery. US Dental Transitions pegs add-on acquisitions at 5 to 8x, regional group purchases at 9 to 11x, and platform-grade practices at 10 to 12x or more. Buyers pay up for specific, checkable things:

• Doctor-independent revenue. Strong hygiene, associates who stay, systems that don't live in the owner's head. The less the cash flow depends on your hands, the smaller the normalization haircut and the higher the multiple.
• Clean, defensible add-backs. TUSK's checklist approach exists because sloppy books cost sellers real money. Personal expenses run through the practice, one-time equipment buys, family members on payroll at above-market rates: each is a legitimate add-back if you can document it and a discount if you can't.
• Scale and durability. Multiple doctors, multiple locations, room to add chairs. A $240,000 EBITDA practice is an add-on. A $2 million EBITDA group is a platform, and the multiple reflects it.
• A competitive process. The spread between one unsolicited offer and a run process is often the difference between the bottom and top of the tier, which is exactly the gap between the 5x and 8.5x cases in TUSK's examples.

What Our Own Numbers Are Telling Us

Two signals from inside The Dental Signal are worth sharing here. Almost everyone can quote a rule-of-thumb percentage of collections. Almost nobody has normalized their own compensation and rebuilt the profit line the way a DSO analyst will on day one of diligence. That information gap belongs to the buyer until you close it.

That's not a coincidence. Thin working capital is one of the quiet forces pushing owners toward institutional buyers in the first place, because a practice that's always tight on cash can't fund the associate hire, the equipment refresh, or the extra operatory that moves it up a valuation tier. If you're searching for working capital answers today, understand that the same constraint is shaping who can afford to buy you tomorrow, and on what terms. A practice that funds its own growth negotiates from a different chair than one that needs the buyer's balance sheet to survive.

The Fine Print That Eats Headline Numbers

One warning before you fall in love with a multiple. Doctor-to-doctor deals and DSO deals differ as much in structure as in price. The dentist buyer typically hands you cash at close and a short transition. The DSO deal comes with equity rollover you can't sell on your own timeline, holdbacks tied to revenue targets, an employment agreement with production requirements, and a non-compete that follows you. Every one of those terms has a dollar value, positive or negative, and none of them appear in the headline number. Get the full deal modeled, after-tax, before you compare anything. A $1.44 million offer with a mandatory four-year workback and a third in rolled equity is not automatically better than $1.15 million in cash from a dentist who takes the keys in 90 days. Sometimes it is. You only know by doing the math on your numbers, your timeline, and your tolerance for someone else setting your schedule.

The Takeaway

Stop asking "what's my practice worth" and start asking "what's my practice worth to each type of buyer," because the answers diverge by six figures. This quarter, rebuild your P&L the way a DSO would: normalize your compensation to a market associate rate, document every add-back, and calculate your adjusted EBITDA alongside your percentage-of-collections number. Then decide which buyer profile you're actually building toward, because the moves that maximize a doctor-to-doctor price and the moves that push you up an EBITDA tier are not the same moves. The owners who get paid best aren't the ones with the best practices; they're the ones who priced both exits years before they needed either.