As Corporate Practice of Dentistry Concerns Escalate, Colorado Enacts Stricter Regulations Over DSO Involvement in Dental Practices
As Corporate Practice of Dentistry Concerns Escalate, Colorado Enacts Stricter Regulations Over DSO Involvement in Dental Practices
As we discussed in this recent post regarding the settlement between Aspen Dental Management and the State of California, the rapid rise and expansion of private equity-backed dental service organizations (DSOs) has raised concerns among regulators that the wide range of management, operational, and clinical responsibilities DSOs assume for purchased practices crosses the line into the prohibited corporate practice of dentistry.
Those concerns are increasingly being codified in state-level laws and regulations designed to put limits on DSO activities and draw a clearer distinction between what does and does not constitute the corporate practice of dentistry in the context of DSO ownership and operation. In December 2025, model legislation -the Independent Dental Practice Act - was introduced that would, if enacted, restrict DSO ownership and the scope of their allowable activities.
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While no state has yet considered the model legislation, some are either drafting or have published regulations specifically designed to prevent DSOs from overstepping their bounds. Illustrative of this trend is Colorado, where the Colorado Dental Board recently adopted new regulations that, while explicitly allowing DSOs to operate in the state, place several important limitations on DSO ownership of practices, real property, and equipment, as well as restrictions on their involvement in clinical decisions.
The rules, adopted as part of the Board’s rulemaking process implementing Colorado’s Dental Practice Act Sunset Bill (SB25-194), take effect January 1, 2027. The framework begins by clarifying that the “proprietor” of a dental practice is considered to be practicing dentistry. That term, as defined in the regulations, “includes any person or entity who employs licensees, owns a dental office, or owns the dental equipment used for providing dental services.”
The Board confirmed that under that definition, DSOs cannot hold the lease for a dental practice’s premises or own equipment used at the dental practice; only the practice itself may do so. Though a DSO cannot serve as the “proprietor” of a dental practice through such ownership of property and equipment, it may provide a practice with administrative, operational, and non-clinical support.
However, anything that approaches involvement in clinical decision-making can run afoul of the regulations and subject the practice and any licensee-owners to disciplinary action. Specifically, a DSO may provide business management services to dental practices so long as:
- Such services do not influence the licensee’s professional judgment and clinical decisions;
- The licensee has immediate access to all patient records for treated patients; and
- The payment to the DSO is not an improper fee-sharing arrangement.
Similarly, a DSO may provide financial management services, including patient account administration, to dental practices so long as:
- The DSO does not interfere with professional judgment;
- The licensee reviews the accuracy of all procedures billed; and
- The licensee retains the ability to modify a patient account if an error is found.
While these regulations only govern Colorado practices and licensees, they are indicative of a trend towards greater scrutiny of DSO involvement in the industry as these organizations continue to grow in size and scope. Given that the overwhelming majority of states prohibit the corporate practice of dentistry, practice owners, regardless of location, should be cognizant of how their relationship with a DSO manifests in ownership and operations to avoid regulatory and licensure issues.
If you have questions or concerns about DSOs or are considering selling your practice to one, please call Grogan Hesse & Uditsky at (630) 833-5533 or contact us online to arrange for your free initial consultation.
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At Grogan, Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you.
Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
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