Top 10 largest DSOs include a mix of oldies and newbies

Dental Team Masks

The list of the top 10 largest dental service organizations (DSOs) in the U.S. looks a lot like our list from 2022, with Heartland Dental, TAG - The Aspen Group, and Pacific Dental Services holding on to the top three spots. But some newcomers disrupted the list.

Though Heartland Dental added 151 practices in 2022, galvanizing its place as the largest DSO, Smile Doctors and Freedom Dental made the list for the first time. Their move to the top 10 knocked out their competitors North American Dental Group and InterDent.  

Meanwhile, TAG - The Aspen Group, which includes Aspen Dental and ClearChoice Dental Implant Centers, reached a milestone in September 2022. It opened its 1,000th Aspen Dental practice and added nine more ClearChoice Dental Implant Centers.

Also on the list is health and wellness company Sonrava Health, which includes DSO Western Dental. The company came in fifth on the list, thanks to the acquisition of DSO Mid-Atlantic Dental Partners, which was completed in June 2022.

Top 10 largest DSOs

Organizations are ordered by the number of affiliated practices. All company websites were last accessed on June 2, 2023.

1. Heartland Dental

Number of affiliated/supported practices/offices: 1,700+
Brands: Individualized
Locations: 38 states
Note: In addition to adding 151 practices in 2022, Heartland stated it opened 84 de novo locations and affiliated with 67 newly supported practices. The DSO plans to further expand in 2023.
Source: Press release dated February 1

2. TAG – The Aspen Group

Number of affiliated/supported practices/offices: 1,100
Brands: Aspen Dental, ClearChoice Dental Implant Centers
Locations: 45 states
Note: In July 2022, TAG opened the TAG Oral Care Center for Excellence in Chicago to provide care to underserved residents. The clinic aims to treat about 2,500 patients annually.
Source: Press release dated March 2

3. Pacific Dental Services

Number of affiliated/supported practices/offices: Nearly 1,000
Brands: Individualized
Locations: 25 states
Note: Recently, Pacific Dental Services partnered with High Point University in North Carolina to extend the use of electronic health record software Epic for use in the Workman School of Dental Medicine and its affiliated dental practices.
Source: Press release dated April 19

4. Smile Brands

Number of affiliated/supported practices/offices: Nearly 700
Brands: Bright Now! Dental, Castle Dental, Merit Dental, Midwest Dental, Monarch Dental, Mondavi Dental, A+ Dental Care, Decision One Private Practice Group, and Johnson Family Dental
Locations: 30 states
Note: Smile Brands has not added any new practices since our 2022 list.
Source: Company website

5. Sonrava Health

Number of affiliated/supported practices/offices: 560
Brands: Western Dental, Mid-Atlantic Dental Partners, Brident Dental & Orthodontics, and Vital Smiles Dental & Orthodontics
Locations: 20 states
Note: In January, Sonrava Health named Dr. Arpankumar Patel, MPH, as its clinical director for the Dallas area, where he supports 46 Brident Dental & Orthodontics practices and other affiliate offices.
Source: Company website

6. MB2 Dental

Number of affiliated/supported practices/offices: 550
Brands: Individualized
Locations: 38 states
Note: In May, MB2 Dental secured a $150 million loan to fund upcoming practice acquisitions.
Source: Press release dated May 2

7. Affordable Care

Number of affiliated/supported practices/offices: 425+
Brands: Affordable Care Dentures & Implants, DDS Dentures + Implant Solutions, Advanced Dental Implant Center
Locations: 42 states
Note: More than 8 million people have received care from Affordable Care-affiliated practices.
Source: Company website

8. Dental Care Alliance

Number of affiliated/supported practices/offices: 400+
Brands: Individualized
Locations: 22 states
Note: In 2022, Dental Care Alliance formed an adult specialty division to complement its general dentistry and orthodontics and periodontics divisions.
Source: Company website

9. Smile Doctors

Number of affiliated/supported practices/offices: 390+
Brands: Individualized
Locations: 28 states
Note: Since the start of 2023, Smile Doctors had added 21 new clinics to its network.
Source: Press release dated April 18

10. Freedom Dental

Number of affiliated/supported practices/offices: Nearly 350
Brands: Individualized
Locations: 42 states
Note: In April, Freedom Dental completed the acquisition of dntl bar in New York City.
Source: Press release dated April 10

Honorable mention

Great Expressions Dental Centers
Number of affiliated/supported practices/offices: 349
Brands: Great Expressions, Ascent Dental Care
Note: In 2022, Great Expressions partnered with Ascent Dental Care practices.
Source: Company website

The list of the largest DSOs is based on's research of readily available public information. The information presented is not meant to be definitive but rather to provide a snapshot of the available data on the largest DSOs. In each instance, the information has been gathered through an organization’s website, press releases, previously published material, or other sources.

Some companies and information are not on this list because the information could not be confirmed by press time. If you are aware of missing information or an organization that should be on the list, please contact us.

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