Join Ryan Mingus, Managing Director and Partner at TUSK Practice Sales, and Josh Swearingen, Director of Mergers & Acquisitions at TUSK Practice Sales, for a candid conversation on the reality of unrepresented offers and what actually happens when a DSO or private equity-backed group comes knocking.
Josh spent years on the buy side of dental M&A, where he was responsible for evaluating practices and structuring the very offers this webinar addresses. In this session, he and Ryan walk through the three priorities shaping every acquisition: the operational efficiencies buyers expect to capture, the risk factors that influence how they value your practice, and the financial model that explains how DSOs profit from the gap between what they pay you and what they ultimately sell for. They also cover how buyers build their internal proformas, why your CPA’s EBITDA and a buyer’s multiple are often two very different figures, and where unrepresented sellers most commonly lose value, from the initial offer through the quality of earnings process and final deal structure.
If you have an offer in hand or simply want to understand how buyers are thinking about practices like yours, this is a webinar worth watching.
Speaker
Ryan Mingus
Managing Director & Partner, TUSK Practice Sales
Ryan brings 12-plus years of sales and leadership experience in the dental and healthcare industry. Most recently, he served as Business Development Director for Strategy and Optimization at Align Technology, Inc., advising partners on growth and performance strategy. Prior to that, he was a Senior Consultant at ECG Management Consultants, where he worked with hospital systems, medical groups, and surgery centers on M&A, valuations, and joint venture planning. Ryan earned his B.A. in Economics and Business from the Virginia Military Institute and his M.B.A. from the University of San Diego. He also served as a Captain in the U.S. Army National Guard.
Speaker
Josh Swearingen
Director, TUSK Practice Sales
Josh brings over 15 years of leadership experience in the dental and healthcare industry. Most recently, he served as CEO of Vesper Alliance, a DSO operating across Cincinnati and Columbus, OH. Prior to that, he served as Director of Corporate Development at American Dental Partners, where he quarterbacked several of the firm's largest transactions. Josh earned his B.S. from The Ohio State University.
Frequently Asked Questions
Why do DSOs send unsolicited offers to dental practice owners?
DSOs have entire teams dedicated to finding practice owners who are willing to sell without representation, and there’s a straightforward reason for that. When there’s no advisor involved, no competing process, and no other offers on the table, the buyer controls everything including the timeline, the terms, and the valuation. This is nothing personal, it’s simply how the model works. But what that means for a selling doctor is that the offer in front of you was structured entirely in the buyer’s interest, and without something pushing back on it, that’s likely where it stays. Understanding this is worth knowing before you engage in any conversation with a potential buyer.
What risk factors do DSOs consider when evaluating a dental practice?
DSOs consider a range of risk factors when evaluating a practice, and each one has a direct impact on the offer you receive. How long do you plan to keep practicing? If the answer is two or three years, that’s a concern for most buyers, and it will show up in the number. Is your practice fee-for-service heavy? That introduces real uncertainty around whether collections hold up once the transition happens. Where is your practice located? Some markets attract aggressive competition among buyers, and others get quietly discounted before an offer is even drafted. And right now, the capital environment matters more than it used to with rising interest rates and recapitalization pressures, meaning that not every group actively pursuing acquisitions has the ability to follow through on them.
What should I do if a DSO approaches me directly with an offer?
The most important thing you can do is slow down. DSOs are experienced acquirers who run these transactions regularly, and the process is designed to move quickly and create a sense of urgency on the seller’s side. Before engaging further or signing anything, it’s worth understanding what your practice is actually worth. TUSK offers complimentary TUSKVals to give you that baseline, so that when you’re looking at an offer, you’re evaluating it against a number you can trust rather than one the buyer provided. That context alone can change everything about how you approach a sale.