Largest DSOs in the US in 2026: A Sourced List by Published Office Count

Every list of the largest DSOs disagrees with the next one. One list gives a group one figure, the next gives another, and a third counts locations that include urgent care and pet clinics. If you run operations for a growing dental group, sell to DSOs, or are weighing an offer for your own practice, you need numbers you can check, not numbers repeated from the last list.

This list uses only figures we could open on each DSO's own website or in its own press release, read on 4 November 2026, with the unit exactly as the DSO publishes it. Where a DSO publishes no count we could open, it is listed separately instead of guessed. After the ranked table come a plain answer to what a DSO is, each organization in turn, what DSO growth means in ADA data, and what the list tells a group that is scaling, including the technology side that rankings leave out. For how support for multi-location groups works, see our DSO IT support page.

What are the largest DSOs in the US in 2026?

Ranked by each organization's own published count, the top five are Heartland Dental, Aspen Dental, PDS Health, Smile Brands and Smile Doctors. Together those five publish more than 5,200 offices, practices or locations. Below them, Sonrava Health, Dental Care Alliance and Affordable Care each publish roughly 400.

Counts read on each organization's own site or release on 4 November 2026. DSOs grow by acquisition every month, so a figure can be out of date within weeks. Large groups that publish no count, including MB2 Dental, are listed below without a number.

A note on units: an "office," a "practice," a "dental site" and a "location" are not always the same thing. A practice with two buildings may count once or twice. Treat any rank gap under about 10% as a tie.

What is a DSO?

A dental service organization (or dental support organization) is a company that runs the non-clinical side of dental practices, such as billing, marketing, human resources, purchasing and often IT, under a contract with the practices, while licensed dentists keep clinical control. Ownership models range from private-equity-backed to entirely dentist-owned.

The ADA Health Policy Institute uses the same test: a practice is DSO-affiliated if "some outside entity manages some or all of its non-clinical functions." Ownership varies widely, as the table below shows. Our guide to what DSO IT support covers explains which technology jobs a DSO usually centralizes and which stay with each office.

How DSOs on this list describe their ownership

Most other organizations on the list do not state their ownership on the pages we read. If ownership matters to your decision, ask for it in writing; it can change with a single recapitalization.

How to compare two DSO counts

Before you treat one group as bigger than another, check five things:

• • The unit. Offices, practices, dental sites, locations and dentists are different measures. A dentist count cannot be compared with an office count.
• • The date. A release from a year ago can be well behind the current figure. Prefer the newest dated figure.
• • What is included. A parent company's total can include non-dental brands, as The Aspen Group's 1,400+ locations do.
• • Supported or owned. "Supported," "affiliated" and "allied" describe a contract, not always ownership.
• • General or specialty. A 200-office endodontic or orthodontic group is a different business from a 200-office general group, with different software and imaging.

The largest DSOs, one by one

Each entry gives what the organization publishes about its size, footprint and model, in its own words where it matters, plus anything public about its technology. We do not comment on how any DSO treats its dentists or patients; that is not something a public count can show.

1. Heartland Dental

Heartland announced on 21 October 2026 that it "has reached 2,000 supported dental offices" across "38 states and the District of Columbia," affiliating with "over 3,200 doctors," and that it is "majority owned by KKR." The release is datelined Effingham, Illinois. Heartland keeps growing by group affiliation: on 2 October 2026 it welcomed Foundation Dental Partners, "with 33 supported practices across Georgia, Tennessee, South Carolina, and Kentucky," and listed "artificial intelligence powered by VideaAI, digital scanning and aligner technologies" among the tools those practices gain.

2. Aspen Dental (The Aspen Group)

Aspen Dental's About page shows "1100+" Aspen Dental offices and says TAG's Practice Support Center is headquartered in Chicago; it also says "Aspen Dental-branded dental practices are independently owned and operated by licensed dentists." The parent, The Aspen Group, reported on 10 March 2026 that its supported providers "served more than nine million patients across more than 1,400 locations in 46 states," but that figure covers all of TAG's brands, including ClearChoice, WellNow urgent care, Chapter aesthetics and Lovet pet care. For a dental comparison, use the 1,100+ figure.

3. PDS Health (Pacific Dental Services)

PDS Health reported "a national network of more than 1,000 practices" in February 2026, saying it "opened 77 new practices" in 2025 and "welcomed 83 new practice owners." It describes an "Owner Clinician model." PDS is the clearest public example of a DSO that runs on a medical-grade record system: it says it runs "a mature digital platform that includes Epic," is introducing "SOTA Cloud, a secure, cloud-based imaging and diagnostics platform that will be implemented across practices beginning in 2026," and, through PDS Health Technologies (datelined Henderson, Nevada), offers its "dental-optimized instance of Epic" to other organizations through PDS Health Technologies (March 2026 release).

4. Smile Brands

Smile Brands says: "We have over 600 affiliated dental offices in 29 states." Its homepage gives no headquarters city or ownership.

5. Smile Doctors

Smile Doctors is the only orthodontics-only organization in the top ten. Its November 2025 release, datelined Dallas, counted "more than 560 affiliated practices across 36 states." That release is a year old, so check for a newer one before quoting the figure.

6. Sonrava Health

Sonrava "provides high quality care in over 400 affiliated offices in 20 states" through brands including Western Dental, Brident, DentalWorks, Perfect Teeth and Vital Smiles. Its site lists an address in Orange, California.

7. Dental Care Alliance

Dental Care Alliance shows "approximately 400 allied practices," broken down as "275 General dentistry, 70 Pediatrics & Orthodontics and 45 Adult Specialty dental practices." That breakdown is unusually useful: few DSOs say how much of their footprint is specialty.

8. Affordable Care

Affordable Care, best known for Affordable Dentures & Implants, says it serves "affiliated dentists at 380+ practices in 39 states." Its Support Center is in North Carolina's Research Triangle Park.

9. SGA Dental Partners

SGA describes itself as "dentist owned and dentist led" and supports affiliated practices "across more than 250 dental sites, over 500 dentists, and 26 states." Its site lists Richmond Hill, Georgia.

10. Specialty1 Partners

Specialty1 supports endodontic, oral surgery and periodontic practices and publishes "220+" practices in "29" states. It calls itself a "doctor-founded, doctor-led organization," with a Houston address on its site.

11. North American Dental Group

NADG publishes "200+ Practices" in "15 States" on its homepage.

12. Mortenson Dental Partners

Mortenson says it is "the largest dental support organization that is owned entirely by the dentists we support," through an employee stock ownership plan, and its "At a Glance" figures list no private equity. It supports "over 150 dental practices" (a stat block on the same page shows 156) from a Support Center in Louisville, Kentucky. The page names ten states, though one sentence says nine.

13. 42 North Dental

42 North Dental's homepage says "OVER 100 PRACTICES AND GROWING."

Large groups that publish no count we could open

• • MB2 Dental: says it is "headquartered in Dallas, Texas," "was founded in 2007" and has "partnered with hundreds of general dentists and specialists across the nation" (mb2dental.com/about). Office count: not published on the pages we read on 4 November 2026.
• • Premier Care Dental Management (Dental365): announced on 21 September 2026 that Virginia "becomes Premier Care Dental Management's Ninth State"; no total office count on the page.
• • SALT Dental Partners: says it provides "support across 23 states and counting"; its practice counter did not display a number.
• • US Oral Surgery Management: lists an Irving, Texas address. Practice count: not published on its About page.
• • Great Expressions Dental Centers and Specialized Dental Partners: their sites did not return a count we could read on 4 November 2026.

How big are DSOs in US dentistry now?

About one in six US dentists works in a DSO-affiliated practice. The ADA Health Policy Institute found 16.1% of dentists were DSO-affiliated in 2024, up from 8.8% in 2017. Among dentists up to 10 years out of dental school the share was 26.5%, more than one in four.

Those figures come from HPI's 2024 practice-modalities data, which analyzed "198,117 out of 212,459 practicing dentists in the U.S." HPI adds that its analysis "still slightly undercounts dentists affiliated with DSOs and larger groups" (ADA HPI data file, 2024; summary on the practice modalities page).

Sources: ADA HPI 2024 data file (published 2025); 2017–2022 figures from ADA News, June 2023; early-career share confirmed in ADA News, November 2025.

Two readings matter for operators. Specialty consolidation is ahead of general dentistry, which is why orthodontic and specialty organizations such as Smile Doctors, Specialty1 and USOSM sit on a list once dominated by general groups. And a third of dentists still practice solo, so the independent office remains the most common setup in the country.

How has the list changed since 2017?

The top three have held their places for nearly a decade, but the scale has more than doubled. DrBicuspid's May 2017 ranking put Heartland at more than 750 affiliated practices, Aspen at more than 600 and PDS at more than 500. In 2026 those three publish 2,000, 1,100+ and more than 1,000.

2017: DrBicuspid, "The 10 largest DSOs in the US", 29 May 2017, which said its figures were "not meant to be definitive." 2026: sources in the main table.

Three names on the 2017 list, American Dental Partners, Great Expressions and InterDent, are not in our 2026 table because we could not open a current count for them. Several 2026 entries, including Smile Doctors, Specialty1, SGA and Mortenson, were not in the 2017 top ten at all.

What the largest DSOs show a group that is scaling

The organizations at the top of this list grew mostly by acquisition and affiliation, which means they solved the same problem every growing group hits: bringing offices with different software, networks and habits onto one way of working. Rankings count offices. They do not show the integration work behind each one.

Three patterns are visible in what these DSOs publish:

• • A single platform is the end state. PDS runs Epic and is rolling out cloud imaging across its practices from 2026. Most groups will not go that far, but the direction is the same: one practice system, one imaging approach, one identity system.
• • Technology is part of the offer to affiliating practices. Heartland's announcement listed AI imaging, digital scanning and aligner technology among what joining practices gain. Groups that compete for affiliations are expected to bring a working technology stack, not a to-do list.
• • Specialty groups scale on a different stack. Orthodontic, endodontic and oral surgery groups run specialty software and imaging (for example 3D and CBCT) that general-dentistry standards do not cover.

The IT checklist for a group adding offices

• • Day-one access. Who controls the new office's domain, email, firewall and practice-software admin accounts on the day the deal closes?
• • Software inventory. Which practice system, imaging software, sensors and phone system does the office run, and which version?
• • Image archive. Where are the x-rays and CBCT scans, how large is the archive, and does it open in your standard viewer?
• • Data agreements. Which vendors hold patient data, and does each have a business associate agreement in your group's name?
• • Network and security baseline. Firewall age and support status, an air-gapped or immutable backup copy that has been test-restored, multi-factor authentication on email and remote access.
• • Cutover plan. A date to move the office onto the group's standard, with a rollback if imaging or the schedule breaks.

Our guide to IT due diligence for a dental practice acquisition walks through each item in detail.

What to verify before you sign with a DSO

If you are a practice owner considering an offer from a DSO, ask technology questions before you sign, because the answers decide what happens to your data and your staff's daily tools after closing. Ask what software you will move to, when, who owns the patient records, and what happens to your images.

• • Which practice-management and imaging software will the office use after the transition, and on what timeline?
• • Will your historical x-rays and scans be migrated, archived read-only, or left on the old server, and who pays for each?
• • Who holds the business associate agreements with your current vendors after closing?
• • Who will support your computers and network day to day: the DSO's central team, a regional provider, or someone you choose?
• • What happens to your phone numbers, website and email domain?
• • If the affiliation ends, how do you get your records back, in what format?
• • Where will the office's backups live after closing, is there an offline or air-gapped copy, and when was a restore last tested?
• • When the practice software, imaging or phones fail, who coordinates with those vendors, and is that included in the support fee the office pays?

These are not legal questions, but your attorney will want the answers in writing.

Where IT fits for groups that are not on this list yet

Most dental groups are far smaller than the organizations above: two to fifty offices, often with a mix of software from each acquisition. That is where standards make the biggest difference, because each new office either joins the standard or adds another exception to support.

Legend Networking is a Dallas-based dental IT company that has served over 3,500 practices since 2004, with 24/7 monitoring and in-house engineers; no outsourced first-level triage. The author, Ian Lynch, has 22 years in dental IT and oversees the NOC, onsite dispatch and client technology roadmaps. Practices rate the company 4.8 from 173 Google reviews. For how multi-location support works, see DSO IT support; for how providers compare, see dental IT support companies compared; and see projects we have published.

Groups evaluating technology at scale may also want our roundup of AI tools for dental practices, the cloud-based dental practice management software comparison, dental practice analytics software, and the DSO events in our dental conferences 2026 calendar.