What are the largest DSOs in the US in 2020?

Dec. 17, 2020

Dr. Chris Salierno did a little research to answer your questions about who rules the DSO world. The top three remain pretty solid in their positions. The rest of them are gaining ground. Did your DSO make the cut?

Chris Salierno, DDS, Chief Editor, Dental Economics

It was announced earlier this month that Smile Brands acquired Midwest Dental, which resulted in a new, super DSO with 650 locations. Does this acquisition put Smile Brands into the top three DSOs? Who rounds out the top five? Let’s find out.

Heartland is still the largest DSO. Their LinkedIn page claims that they have more than 1,000 locations, which places them in the top spot by a decent margin.

The second and third positions are traditionally held by Aspen Dental and Pacific Dental Services, respectively. Their LinkedIn pages state that they have “over 800 locations,” so we’ll have to dig deeper to get more concrete numbers. I found this data site that sets the number of Aspen Dental locations at 874. No such luck finding real numbers for PDS, so we’ll assume they have between 801 and 874 locations and keep them in third place.

Smile Brands has been solidly in the number four spot for a few years now. The recent acquisition of Midwest Dental will not place them in the top three, but it will definitely help them hold their position against the serious competition discussed here. This is where things get interesting.

According to my research, it is a very close race for the position of fifth largest DSO in the US. The contenders are Great Expressions, which states it has 349 locations, Affordable Dentures, which states it has more than 340 locations, and Western Dental, which states it has nearly 320 locations.

There has been a lot of DSO growth in 2020, and this has been partially attributed to the COVID-19 pandemic. While the top three DSOs have seen steady growth in their number of locations for years, there is significant activity in the rest of the top DSOs. If there are deals next year that are similar to the Smile Brands acquisition, we could potentially see a number five contender usurp Smile Brands for number four. For now, however, the top three will continue to rule uncontested.

Chris Salierno, DDS, is the chief editor of Dental Economics and the editorial director of the Principles of Practice Management and Group Practice and DSO Digest e-newsletters. He is also a contributing author for DentistryIQ and Perio-Implant Advisory. He lectures and writes about practice management and clinical dentistry. Additional content is available on his blog for dentists at ToothQuest. Dr. Salierno maintains a private general practice in Melville, New York. You may contact him by e-mail at [email protected].

About the Author

Chris Salierno, DDS | Chief Editor, Dental Economics

Chris Salierno, DDS, is the chief editor of Dental Economics and the editorial director of the Principles of Practice Management and Group Practice and DSO Digest e-newsletters. He is also a contributing author for DentistryIQ and Perio-Implant Advisory. He lectures and writes about practice management and clinical dentistry. He maintains a blog to answer patient questions at ToothQuest. Dr. Salierno maintains a private general practice in Melville, New York. You may contact him at [email protected].

Updated Dec. 4, 2020