8/9/2019 DSO Organizational Chart- By Michael W. Davis, DDS

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Basic Organizational Chart of Chain Dental Clinics in the US  by Michael W. Davis, DDS

DSO (Dental Service Organization)

A DSO is initially the beneficial owner of dental practices, prior to sale to ! fir". #his entity

allegedly only "anages the non$clinical aspects of the dental practices via Manage"ent

Service Agree"ents (MSA). %et, they oversee clinical prod&ction '&otas and bon&ses, controlclinic ban acco&nts, control clinic staffing, control no"inee dental clinic owners on who the

o"inee Dentist "ay b&y * sell the dental practice, dictate clinic ho&rs * staffing, and

establish * control patient s&pplies, e'&ip"ent, sched&ling, clinical protocols and

laboratories. Once p&rchased by a ! fir", they beco"e a s&bordinate "anage"ent ar" to

the ! fir". Office Managers, e"ployees of the DSO oversee the clinic operations for the DSO.

Private Equity Firm

(+eneficial Owner of Dental linics)

! fir"s are established as first lien creditor or "ezzanine financier for acco&nting p&rposes *

not -owner, to shelter profits fro" lawf&l ta/ation. #heir directors and "anagers are

responsible for every aspect of the dental clinics, which they beneficially own. #hey control

the board of directors of the DSO. #hey &lti"ately select the DSO "anagers.

Patients 

+eca&se of patients0 lac of e/pert infor"ation and training in the dental

profession, they are highly v&lnerable. 1n the doctor2patient relationship (a

lawf&l contract) doctors are ethically and legally re'&ired to place patient

interests above all others, incl&sive of &ndisclosed third parties (interests of

DSOs). atients are generally f&lly &naware of their doctor0s conflict of

interest. A lac of f&ll and open disclos&res, layers of conflicts of interests,

and a series of "isrepresentations f&rther co"pro"ise the patient0s standing

in the doctor2patient contract.

Nominee Dentist Owner

(#his is a sha" or fig&rehead dentist owner) 

#his position is often re'&ired to circ&"vent state stat&tes on

dental clinic ownership. #hese doctors are retained for potential

dental clinic liability da"ages (ad"inistrative, civil, or cri"inal

law). %et, they wield no real power or control. #hey "ay not

freely sell what is alleged to be their asset3 the dental practice.

#hey have no control over what is alleged to be their clinic0s

finances. #hey are contract&ally obligated (via the MSA) to

retain the services of the DSO into perpet&ity. #hey are f&lly

s&bordinate as e"ployees or shell entities, to the DSO and

receive a "anage"ent fee for each clinic for which they clai"

ownership. 

Emloyee !ssociate Dentists 

#hese are doctor e"ployees f&lly s&bordinate

to DSO "anagers, who are often &nlicensed topractice dentistry. #his "ay or "ay not incl&de

s&bordination to a no"inee dentist owner, who

is also an e"ployee * s&bordinate of the DSO.

#hey generally have little contact with the

&lti"ate Private Equity Firm"s directors. #h&s,

the ! fir" is afforded layers of liability

protection, altho&gh they are the &lti"ate shot$

callers.)