DSO Affiliation by State
The ADA’s survey says 16.1% of US dentists are DSO-affiliated. Public records tell a complementary story: the share of practices with visible DSO affiliation runs from 1.0% in Wyoming to 14.8% in North Dakota across the 42 license-enriched states plus DC. One is self-reported; ours is a verifiable floor, refreshed weekly. Both are true, and the spread between states is the story.
Visible DSO affiliation snapshot
Visible DSO affiliation, ranked by state
Every license-enriched state, ranked by the share of active dentists whose DSO affiliation is visible in public records. This is a floor, not a total: a practice without a flag is one whose affiliation we could not see, not one known to be independent. Select a state for its full dental market page. For raw dentist counts and per-capita supply, see dentists by state.
| Rank | State | Visible DSO share | Dentists per 10K residents |
|---|---|---|---|
| 1 | North Dakota | 14.8% | 1.8 |
| 2 | South Dakota | 12.7% | 2.0 |
| 3 | Indiana | 11.9% | n/a |
| 4 | Minnesota | 11.8% | 3.3 |
| 5 | New Mexico | 11.7% | 3.3 |
| 6 | Tennessee | 10.9% | 2.8 |
| 7 | Colorado | 10.2% | 5.2 |
| 8 | Nevada | 9.8% | 3.9 |
| 9 | Arizona | 9.1% | 3.6 |
| 10 | Oklahoma | 9.0% | 3.4 |
| 11 | Texas | 8.2% | 3.2 |
| 12 | Florida | 8.0% | 3.1 |
| 13 | Arkansas | 6.2% | 2.6 |
| 14 | New Hampshire | 5.9% | 3.8 |
| 15 | Louisiana | 5.6% | 1.9 |
| 16 | District of Columbia | 5.5% | 4.3 |
| 17 | Iowa | 5.3% | 3.4 |
| 18 | Missouri | 5.2% | 3.6 |
| 19 | Massachusetts | 5.1% | 4.7 |
| 20 | Connecticut | 5.0% | 4.2 |
| 21 | Ohio | 4.8% | 2.5 |
| 22 | Alabama | 4.7% | 2.6 |
| 23 | Kentucky | 4.4% | 3.3 |
| 24 | North Carolina | 4.4% | 3.7 |
| 25 | Pennsylvania | 4.4% | 4.0 |
| 26 | California | 4.3% | 4.6 |
| 27 | Michigan | 4.3% | 4.3 |
| 28 | Illinois | 4.0% | 4.1 |
| 29 | Idaho | 3.9% | 4.1 |
| 30 | Wisconsin | 3.8% | 5.1 |
| 31 | Delaware | 3.6% | 1.7 |
| 32 | Kansas | 3.6% | 3.3 |
| 33 | Rhode Island | 3.5% | 3.4 |
| 34 | Oregon | 3.2% | 6.2 |
| 35 | Maine | 3.0% | 5.0 |
| 36 | Washington | 2.8% | 4.6 |
| 37 | Alaska | 2.4% | 4.5 |
| 38 | Hawaii | 2.4% | 4.9 |
| 39 | New York | 2.1% | 4.4 |
| 40 | Vermont | 2.0% | 3.2 |
| 41 | New Jersey | 1.7% | 4.4 |
| 42 | Wyoming | 1.0% | 3.4 |
| 43 | West Virginia | 0.0% | n/a |
Methodology: a visible-affiliation floor
Affiliation is inferred from four families of public-records signals: canonicalized brand-name matching against a registry of 200+ DSO brands and their legal-entity aliases, multi-location and shared-infrastructure patterns (the same organization across several buildings, or multiple legal entities sharing one dispatch phone), brand-published office locators re-scraped monthly as ground truth, and corporate-officer clustering in NPPES registration data. Flags refresh weekly. The number is a floor by construction: chains that file acquired offices under unrelated local practice names can be invisible to any public-records method, so a practice without a flag is unclassified, not confirmed independent. The full walkthrough, including where the measurement stops, is in how we measure DSO affiliation.
Brands in the locator ground-truth corpus
The name registry canonicalizes 200+ DSO brands. These are the brands whose public office-locator directories we re-scrape monthly as ground truth for the classifier:
Common questions
What share of dental practices are DSO-affiliated?
Two complementary numbers answer this. The ADA Health Policy Institute's survey benchmark is 16.1% of US dentists as of 2024, self-reported nationally. ProviderSignal measures the share of practices whose DSO affiliation is visible in public records: a verifiable floor, computed per state and refreshed weekly. That visible-affiliation floor currently runs from 1.0% in Wyoming to 14.8% in North Dakota across the 42 license-enriched states plus DC.
What is a DSO (dental support organization)?
A DSO is a company that provides non-clinical business services to dental practices: procurement, billing, HR, marketing, and real estate, typically under long-term support agreements. Practices affiliated with a DSO often buy supplies through corporate procurement rather than deciding office by office, which is why supply reps, acquisition teams, and practice brokers track affiliation closely.
Why are these figures different from the ADA's 16.1%?
They measure different things. The ADA asks dentists and gets a self-reported national total. We read the public record and get a per-state, externally verifiable minimum. A public-records floor should come in under a self-reported total: many affiliations leave no public trace, for example when a chain files an acquired office under a local professional-corporation name. Neither number invalidates the other.
Which states show the most visible DSO affiliation?
As of the latest weekly refresh, the highest visible-affiliation states are North Dakota (14.8%), South Dakota (12.7%), Minnesota (11.8%). The full table below covers every license-enriched state, and each state links to its full market page.
If a practice is not flagged as DSO-affiliated, is it independent?
Not necessarily. Our number is a floor: a practice we do not flag is one whose affiliation we could not see in public data, not one we know to be independent. Chains that file offices under unrelated local practice names can be invisible to any public-records method, which is exactly why we publish the figure as a visible-affiliation floor.
How does ProviderSignal detect DSO affiliation?
Four families of public-records signals: canonicalized brand-name matching against a registry of 200+ DSO brands and their legal-entity aliases, multi-location and shared-infrastructure patterns (shared addresses and dispatch phone numbers across legal entities), brand-published office locators re-scraped monthly as ground truth, and corporate-officer clustering in NPPES registration data. No single signal is complete on its own; the flags refresh weekly.
Who uses this data
DSO affiliation is one signal in a larger dental market dataset. The same public sources power territory and acquisition intelligence for the teams that work with dental practices every day.
Territory trigger feeds, license expiration alerts, and practice profiles for reps who sell into dental offices.
DSO acquisition teamsDSO affiliation mapping and practice-level signals for buy-side sourcing.
Practice brokersRetirement-age and license signals for finding practices likely to transition.
Our data sourcesEvery dataset behind these numbers: NPPES, state dental boards, Medicaid fee schedules, CMS, and OIG exclusions.