Top 10 DSOs in the U.S. ranked

Dental Operatory Obscured

While dental service organizations (DSO) Heartland Dental, TAG - The Aspen Group, and Pacific Dental Services maintained their stronghold as the top three largest DSOs in the U.S., respectively, they may want to keep an eye on DSO MB2 Dental.

For the first quarter of 2024, MB2 Dental again moved up the ranks and further expanded in the U.S. MB2 Dental, which expanded the most, adding a staggering 100 new practices between June and December 2023 on DrBicuspid’s last ranking of the top DSOs. Also, MB2 Dental tied for fourth place with DSO Smile Brands, with both boasting nearly 700 practices.

Additionally, DSOs Affordable Care and Dental Care Alliance, both of which made it on DrBicuspid's top 10 list in June 2023, expanded into new states.

Top 10 DSOs

Organizations are ordered by the number of affiliated practices. All company websites were last accessed on March 14, 2024.

1. Heartland Dental

Number of affiliated/supported practices/offices: 1,700+
Brands: Individualized
Locations: 38 states and the District of Columbia
Note: In January, Heartland Dental announced several milestones, including adding 94 supported practices and relocating its existing offices, in 2023.
Source: Press release dated January 31.

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 March, the 100th ClearChoice Dental Implant Center was opened in New Jersey.
Source: Company website

3. Pacific Dental Services

Number of affiliated/supported practices/offices: Nearly 1,000
Brands: Individualized
Locations: 24 states
Note: In January, Pacific Dental Services announced numerous milestones, including awarding scholarships to dental assisting students and treating more than 1,000 patients in Guatemala.
Source: Company website

4. Smile Brands (tied)

Number of affiliated/supported practices/offices: Nearly 700
Brands: 75 brands, including 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 in 2023 or during the beginning of 2024.
Source: Company website

4. MB2 Dental (tied)

Number of affiliated/supported practices/offices: Nearly 700
Brands: Individualized
Locations: 40 states
Note: In February, MB2 Dental entered West Virginia, partnering with two locations in the state.
Source: Company website

5. Sonrava Health

Number of affiliated/supported practices/offices: Nearly 600
Brands: Western Dental, Mid-Atlantic Dental Partners, Brident Dental & Orthodontics, Rich Orthodontics, DentalWorks
Locations: 21 states
Note: In March, Sonrava Health, which includes DSO Western Dental, named a new chief revenue operations officer.
Source: Company website 

6. Affordable Care

Number of affiliated/supported practices/offices: 440
Brands: Affordable Care Dentures & Implants, DDS Dentures + Implant Solutions, Advanced Dental Implant Center
Locations: 43 states
Note: In January, Affordable Care announced the retirement of its CEO Gene Kirtser.
Source: Press release dated January 4.

7. Smile Doctors

Number of affiliated/supported practices/offices: 430
Brands: Individualized
Locations: 29 states
Note: In February, Smile Doctors announced that it has six de novo locations in development for 2024.
Source: Company website

8. Dental Care Alliance 

Number of affiliated/supported practices/offices: 400+
Brands: Individualized
Locations: 24 states
Note: In March, Dental Care Alliance expanded into New Hampshire.
Source: Company website

9. Freedom Dental

Number of affiliated/supported practices/offices: 350+
Brands: Individualized
Locations: 42 states
Note: Freedom Dental has not added any new practices in 2024.
Source: Company website

10. Great Expressions Dental Centers

Number of affiliated/supported practices/offices: 349
Brands: Great Expressions, Ascent Dental Care
Locations: 10 states
Note: In December 2023, Great Expressions announced that it had treated nearly 134,000 new patients in 2023.
Source: Company website

Honorable mention: North American Dental Group

Number of affiliated/supported practices/offices: 240+
Brands: Individualized
Locations: 15 states
Note: In June 2023, dentists in the U.S. sued Zahn Parent, an affiliate of North American Dental Group, seeking data that will explain what may have diluted their ownership shares in the firm, potentially hurting their retirement and finances.
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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