When a DSO evaluates your practice, they don’t just glance at your collections and throw out a number. Behind every offer is a structured, methodical checklist. It’s rarely shared with sellers, but it determines everything about the offer you receive.

Most dentists never see this checklist. They assume that high revenue or a strong reputation is enough. But inside the DSO deal room, there is a clear set of criteria that shapes valuation, structure, and how aggressively buyers compete for your practice. If you understand this checklist before you sell, you can position your practice to check more boxes and command a premium.

For many dentists, “value” is a simple equation. If collections are high, the practice must be worth more. It feels intuitive. After all, more revenue should mean more profit, and more profit should mean a higher sale price. But when it comes to selling to a DSO, this assumption can be dangerously misleading.

DSOs do not base their valuations on top-line revenue alone. They look deeper. They analyze the quality of earnings, operational systems, growth capacity, staffing stability, payer mix, and dozens of other factors that most practice owners rarely think about. Two practices can have identical collections but sell for vastly different prices. One might command three times its profit, while the other struggles to get a competitive offer.

The difference lies in what DSOs truly value, and if you understand those drivers in advance, you can position your practice to command a premium.

Most dentists know that selling to a DSO can lead to life-changing financial outcomes, but very few understand the timeline that gets them there. They assume the process is as simple as receiving an offer, signing some papers, and handing over the keys. The reality is far more structured, and those who understand the stages in advance move through the process with less stress, stronger positioning, and better outcomes.

Over the years, I have guided hundreds of millions of dollars in dental practice transactions. Every successful sale follows a timeline. The details may vary, but the phases are consistent. If you know what to expect, you can prepare strategically and avoid costly surprises.

Most doctors believe the value of their practice is fixed. They think a broker gives them a number, and that number represents their fate. In reality, strategic positioning can completely rewrite the outcome. I’ve seen practices increase their sale price by millions simply by approaching the process the right way.

One recent deal stands out as a textbook example of what happens when a high-performing practice is strategically positioned for the DSO market. The doctor didn’t just get a good deal. He tripled their practice value.

For many dentists, the first step toward selling their practice is calling a broker and getting a valuation. It feels logical. Brokers have been around for decades. They know the market, they give you a number, and that number becomes the foundation for your expectations. But in today’s DSO-driven market, relying on a traditional broker valuation is one of the most expensive mistakes you can make.

Broker valuations often use outdated methods that do not reflect what sophisticated buyers actually pay for. The result is millions of dollars in hidden equity left on the table. The market has changed. The way your practice is valued must change with it.

The dental market is shifting again. The frantic, gold-rush phase of DSO acquisitions is giving way to something more selective, more strategic, and far less forgiving.

In 2026, simply having a good practice will not guarantee a premium offer. Buyers are sharpening their pencils. Capital is tightening. Competition among sellers is increasing.

The practices that thrive will be the ones that approach their sale strategically. The ones that stumble will be those that treat it like a routine transaction. Next year will separate the strategists from the sellers.

When the big offers start rolling in, most dentists think the hard part is over. They believe that finding the right buyer is the challenge and that once a Letter of Intent is signed, everything else is a formality. The reality is far different.

The real game begins inside the negotiation room. DSOs do this every day. They have deal teams, analysts, attorneys, and experienced negotiators whose sole job is to structure acquisitions in their favor. Dentists, even those who own multimillion-dollar practices, usually go through this process once. The knowledge gap is massive. And that gap costs doctors millions of dollars every year.

After working on hundreds of millions in dental transactions, I’ve seen the same traps catch practice owners over and over again. They are avoidable, but only if you know they are there.

If you own a thriving dental practice generating seven figures or more, the decisions you make in the next twelve months could define the financial legacy of your entire career. Right now, the dental industry is in the middle of a massive consolidation wave. DSOs are buying aggressively. Private equity money is flowing in. And practice valuations for top-performing offices are at levels most doctors have never seen before.

This is a real, measurable shift that’s reshaping the economics of dentistry. Those who understand what’s happening and act strategically are walking away with life-changing outcomes. Those who wait are watching the window narrow.

Here’s the part almost no selling doctors think about…but every buyer fears:

What if the staff walks the minute the seller leaves?

It’s the nightmare scenario buyers whisper about behind closed doors. Because it’s not just inconvenient it’s catastrophic. Imagine dropping millions on a practice, walking in on Day One and finding the front desk in tears, the hygienists cleaning out their lockers, and the assistants already updating their résumés. The charts are full, the phones are ringing, the schedule is packed and there’s no one left to run it.

When a buyer looks at your dental practice, they’re not thinking about your décor, your awards, or even your technology. They’re thinking about whether your patients will still walk through the door once you don’t. And if they’re not sure of the answer… They walk. Or they slash their offer to the bone.

This is the cold, unvarnished truth most sellers don’t want to hear, but buyers obsess over it.
Because from their perspective, buying your practice is like buying a revenue engine… and that engine stops running the second the fuel (you) disappears.