The DSO that called you last month has a team of people whose entire job is acquiring practices like yours. They have done this hundreds of times. You will do it once.

That asymmetry is the single biggest factor in whether you walk away with what your dental practice is actually worth. And it is entirely fixable.

This guide exists to close the gap. TUSK Practice Sales has represented dental practice owners through 200+ transactions totaling more than $1.5B in closed deal value. Every section below reflects what our team has learned working shoulder-to-shoulder with sellers, from the first valuation conversation through closing day and the transition that follows.

Before You List Your Practice: The Work That Determines Your Outcome

Most dental practice owners assume the sale process starts when buyers show up. It doesn’t. The work that happens before you go to market is what determines your outcome more than anything that happens during the sale itself.

The DSOs and PE-backed groups actively pursuing dental practices have dedicated acquisition teams. Each of those teams has negotiated hundreds of transactions. They know what a practice should sell for before they ever send you a letter of intent.

Your job is to know it first. That starts with two things:

A professional practice valuation. Not a back-of-napkin estimate from a broker. A formal, data-backed model that accounts for your financial performance, patient demographics, payer mix, and real market comparables. At TUSK, our valuation models are layered with actual deal outcomes, showing what your practice would likely sell for at the top, middle, and low end of today’s market.

This also answers a question most owners don’t think to ask early enough: is now the right time, or would waiting two to three years meaningfully change what you walk away with? A good advisor will never rush you to sell. TUSK walked one dentist through that exact analysis. Timing the sale created an additional 78% in value.

Getting clear on your goals. Before a single buyer sees your practice, you need to know what you are optimizing for. Is this sale funding your retirement? If so, what is your number? Are you open to staying on clinically for a few years, or is a short post-close commitment non-negotiable? How much does cultural fit matter versus maximizing cash at close?

Your TUSK advisor walks through these questions before the process begins. The answers shape which buyers we approach, how we evaluate their offers, and what a successful outcome looks like for you specifically.

How TUSK Takes Your Dental Practice to Market

A sell-side advisor’s job is to run a competitive process on your behalf while keeping your life as a clinician intact. That means getting your practice in front of the right buyers, keeping the process confidential from staff and patients, managing all inbound buyer communication so you stay focused on production, and creating enough competitive tension that no single DSO can dictate terms.

Here is what that looks like in practice:

Aligning on valuation and deal expectations. You and your advisor get aligned on what your practice is worth and what deal terms matter most to you. Several members of TUSK’s advisory team have owned or managed dental groups before moving into M&A. They understand the demands of the clinical day. Your advisory team works around your schedule and manages the process so you are focused on patients, not paperwork.

Building your CIM. The CIM is the document that introduces your practice to prospective buyers while keeping your identity confidential until they have signed an NDA. This is where your financials and your practice story get fully aligned into a single narrative that positions your practice accurately and competitively.

Running a curated buyer outreach. Your practice deserves more than being posted on a listing page. TUSK runs a targeted, strategically sequenced outreach to the buyers most likely to compete aggressively for your specific practice. In 2025, TUSK closed transactions with 16 unique buyers, including nine first-time buyers for TUSK clients, generating six or more offers on average per transaction. That breadth comes from a systematically maintained buyer network, not a static list.

Vetting every buyer. Financial capacity matters. Cultural fit matters. Post-close employment terms matter. A buyer offering the highest headline number who cannot actually close, or whose integration model would gut what you built, is not the best offer. Your advisor needs to understand what you are optimizing for and vet buyers against that standard.

You Got the Offers. Now What?

Congratulations! Multiple offers are on the table. Now comes the hard part: figuring out which one is actually the best deal.

Buyers construct offers with multiple components: cash at close, post-sale compensation, earn-outs, joint-venture equity, and HoldCo equity. Each one carries its own risk profile, timeline, and set of conditions. The real value of the offer is buried in how those pieces interact.

Here is what actually matters in a letter of intent:

Cash at close. The most certain dollar in the transaction. Most DSO offers deliver 60-80% of the purchase price as cash at close, with the remainder structured as equity. Everything else in the offer carries more risk than this line.

Post-sale compensation. What is your post-close pay calculated on? Collections, EBITDA, or a flat salary? What are the termination provisions? These terms have real financial consequences that the headline number does not reflect.

Earn-outs. Some earn-out structures are well-designed and achievable. Others are not.  Take an LOI where the headline multiple was 8x. That looked strong until we modeled the earn-out. The targets assumed 15-20% EBITDA growth in year one under a DSO cost structure that historically compresses margins by 5-8%. The effective multiple, when we ran the waterfall, was closer to 5.5x. That is a different deal.

Equity: JV and HoldCo. Rolled equity in your own practice or in the parent DSO creates the opportunity for a second financial event at the buyer’s next recapitalization. The value of that equity depends on the platform’s performance, its debt load, and where you sit in the PE hold period. Rolling equity at month five of a 60-month hold cycle is structurally different from rolling at month 55.

At TUSK, we build a waterfall analysis for every offer in a client’s process. It translates each offer into what you actually walk away with (after taxes, fees, and deal terms) at closing and then again at each projected equity event five to seven years out. That is the only honest way to compare offers side by side.

What Happens During Due Diligence?

Once you sign a letter of intent and enter exclusivity, the buyer’s formal investigation begins. Diligence is thorough. It is time-consuming. And if it is not managed well, it can feel invasive.

Your advisor’s job during this phase is to stand between you and the process so you can keep running your practice.

Proactive organization. Before the buyer sends a single request, your advisor assembles the documentation they are most likely to ask for into a secure virtual data room. This signals to the buyer that your practice is well-run and professional, and it shortens the diligence timeline on the front end. Shorter diligence is better for the seller.

Single point of contact. Every buyer request flows through your advisor, not directly to you. This protects your time, ensures your responses are consistent, and gives your advisor visibility into what the buyer is actually focused on. That visibility sometimes tells you more about where deal risk lives than anything the buyer will say directly.

Knowing the line between standard diligence and overreach. Buyers ask for things they do not always need. An experienced advisor knows the difference and pushes back accordingly.

One thing to get right early: do not hide known issues. A lease renewal coming due, a key hygienist who has expressed interest in leaving, a payer renegotiation in process. Your advisor needs to know all of it. Surprises during diligence do not stay small; they become renegotiation ammunition for the buyer. Disclose early, let your advisor frame the narrative, and the cost is almost always lower than a buyer discovering something you hoped they would not find.

You’re at the Finish Line: Protecting Your Legacy After the Sale

The finish line is where some deals quietly go sideways. Either the closing coordination breaks down, or the announcement to the team was treated as an afterthought, and you’re now dealing with disgruntled employees. Both are preventable.

Legal finalization. The move from LOI to a definitive Purchase and Sale Agreement is where the binding terms get documented: representations and warranties, indemnification, post-close covenants, non-compete scope, employment terms. Your attorney handles the drafting; your TUSK advisor stays in the room to ensure deal economics are preserved. Changes that seem minor in legal language can carry significant financial consequences.

Closing coordination. A clean close requires orchestration across lender, buyer’s counsel, your attorney, and both principals, often on a compressed timeline. Your advisor manages the sequencing, tracks outstanding items, and ensures the wire transfer and title transfer happen in the right order.

Transition planning: the piece most sellers underweight. How you announce the sale to your team matters. How you communicate with patients matters. How you introduce the new partner to your referral network matters. There is no single right answer. Some owners introduce the new partner at a staff meeting the morning after closing. Others brief key team members 24 hours or 2 weeks before close so they are not blindsided. What does not work is no plan at all.

Your TUSK advisor helps you build this plan before you are under the pressure of closing week. The practices that retain their best people, hold their patient base, and continue to grow under new ownership are the ones where the transition was treated as seriously as the transaction itself.

You Only Sell Once. Do it Right.

This is the part where most owners breathe a sigh of relief. Your deal has closed, and the wire has hit the account.

The process of selling your life’s work is not a walk in the park. It’s months of preparing financially and emotionally, and negotiating so you’re receiving credit for the great business you’ve built. If there’s one piece of advice, it’s don’t go at it alone. It took a team to get you here today, and you should trust the team that prepares you for the next phase of life.