Dental CPA Insights 

By Spiro Leunes, CPA | CEO, MRL Advisory Group, New Jersey and New York Dental CPAs Reviewed September 2026. Worker classification rules change frequently, and the rules described below may not be the rules in effect when you read this. This is one of the questions I am asked most often, by practice owners and by associates. Should the associate be a 1099 contractor or a W-2 employee? The honest answer is that it is not a choice either party gets to make. Classification is de

By Spiro Leunes, CPA | CEO, MRL Advisory Group, New Jersey and New York Dental CPAs Payroll is the largest expense in most dental practices, and it is also the expense owners are most likely to manage by feel. A hygienist asks for a raise and gets one. An assistant who has been with the practice ten years discovers that the assistant hired six months ago is making almost the same money. December comes around, everyone gets a check, and within a few years that check is no long

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs A buyer sits down with three years of a seller’s financials, works out what the practice earns, and decides what he can pay for it. That is the right exercise. The trouble is that he almost always runs it on the seller’s numbers, and nobody in the room stops to ask whether those numbers travel. Some of them do not. The one that catches buyers most often is the rate the practice actually gets

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs When I analyze a dental practice that's busy but not profitable, the issue is rarely clinical, it's at the front desk. The desk is where production either becomes collections or quietly evaporates, where the hygiene schedule either stays full or develops holes, and where a new patient either books or hangs up and calls the office down the street. I've written about how practices lose profit t

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Hygiene drives the dental practice. That's why the conversations I keep having with practice owners across New York and New Jersey are so concerning. It's no longer simply, "How do I keep my hygiene schedule full?" It's: "I can't find a hygienist to run the column." An empty hygiene column isn't just a staffing problem. It's a production, collections, and practice-growth problem. This Isn't a

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Every dental practice diagnoses more treatment than it completes. The exam is thorough, the diagnosis is sound, and the patient nods, schedules a cleaning, and walks out the door. The crown, the implant, or the periodontal work that was clearly indicated never gets scheduled. That gap has a name. It is called case acceptance, and after more than two decades working with dental practices, I h

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs At some point in nearly every practice owner's career, the same question arrives. Keep paying rent, or buy the building the practice operates in? Sometimes a landlord hints that he would sell. Sometimes a lease renewal arrives with a difficult escalation clause. Sometimes a colleague at a study club has just purchased his own unit and cannot stop talking about it. However it arrives, most den

By Spiro Leunes, CPA | CEO, MRL Advisory Group, New Jersey and New York Dental CPAs Ask ten dentists what their practice is worth and most of them land on the same answer. Somewhere around 70 to 80 percent of collections. That rule has been floating around study clubs for decades, and it still gets repeated at every dinner meeting. The trouble is that it answers a question buyers stopped asking a long time ago. Two offices that both collect $1.5 million can sell for numbers t

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Most dentists only think about taxes in April. That’s exactly why they overpay. By filing time, the game is over. Every decision that could have cut your tax bill has already been made. You’re no longer planning—you’re just reporting history. The most profitable dental practices treat July like a strategic reset. With six months left, you still have time to move the needle on collections, pr

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Most growth advice assumes every dental practice needs more new patients. That may be true if you just opened your doors. It usually is not true if you have been practicing for fifteen or twenty years. If you already have a loyal patient base, a full hygiene schedule, and an experienced team, simply spending more money on marketing is rarely the answer. In fact, it is often the most expensive

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs If you have felt for years that Delta Dental’s reimbursements don’t add up, you’re not imagining it, and you’re not alone. There is now significant litigation moving through the courts on exactly that issue, and as a practice owner you should understand what’s happening, what it could mean for your collections, and how to handle the patient questions that are starting to come up. I want to

By Spiro Leunes, CPA | CEO, MRL Advisory Group — New Jersey & New York Dental CPAs Most practice owners focus on how much money their practice makes. Far fewer pay attention to how that money gets into their pocket — and that second question often matters more to your after-tax income than the first. Here’s the reality that surprises owners: the exact same profit can be taxed very differently depending on your entity structure and the method you use to take it out. Two dentis

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Hiring a dental associate too early can destroy a practice’s cash flow. Conversely, hiring an associate at the right time can dramatically increase production, improve your lifestyle, and significantly increase the long-term value of your practice. For many dentists, adding an associate is the first major transition from being a solo producer to becoming a true practice owner. Done correctly,

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs For many dentists, practice ownership is the single largest financial decision of their career. Eventually, every dentist who wants ownership reaches the same crossroads: do you buy an existing practice or start and build a practice from scratch? In New York and New Jersey, that decision carries significantly more financial risk than it does in lower-cost parts of the country. Aggressive comp

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Dental practices are seeing higher costs and tighter profit margins. PPOs are reducing reimbursements; labor costs continue to increase as do the costs of dental supplies are laboratory bills. The answer to better profitability as you prepare for 2026, isn’t always adding more patients. The answer for established practices may be to change your procedural offering. Every patient that yo

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs In working with dental practices across New Jersey and New York, I see the same pattern repeatedly. The practice is busy. The schedule looks full. But profitability isn’t where it should be. The problem is rarely clinical, it’s operational. Here are the five practice management fundamentals that separate practices that are merely busy from practices that are actually profitable and growing. 1

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Something that comes up regularly in conversations with dental practice owners: the succession plan they built their practice around no longer fits the associate they’re actually working with. It’s not a crisis. But it’s a real shift, and for owners in New York and New Jersey who are within ten years of a transition, it’s worth understanding clearly. How Dentists Think About Ownership Has Cha

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Succession planning is different today than a generation ago. For practice owners in the latter stages of their careers, understanding those shifts and planning accordingly can make a significant difference in who they sell to and the final outcome. Traditional Practice Succession Has Evolved Traditional practice succession had a familiar path. The physician or dentist built a practice, bro

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs I will say this clearly because practice owners need the truth, not theory. Dental practice fraud is not 100 percent preventable. What is preventable is the size of the loss and the length of time it goes undetected. Fraud can go on for many years without the dentist noticing and can amount to several hundred thousand dollars before it is caught. Understanding the Nature of Dental Fraud That

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Dental practices are feeling compression and navigate challenges. In 2026, the successful practices will be the ones that work smarter not harder as busyness doesn’t always equate to higher profitability. The key is for practices to limit preventable profit leaks with the same number of patients and the same number of days. Trend 1: Insurance payments are quietly decreasing your collections

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs If you're a dental or medical practice owner, 2026 is bringing changes you can't ignore: restored bonus depreciation, new 401(k) rules, and tighter meal deductions. Combined with reimbursement pressure and rising overhead, this year demands smarter tax planning—not just year-end scrambling. Today I'm going to break down what's actually new for 2026 dental practice tax planning and medical pra

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Scaling a dental practice from one location to multiple offices is one of the fastest ways to increase profit, build enterprise value, and reduce owner dependency. However, a multi-office dental business is not simply a larger practice. It requires standardized systems, consistent clinical protocols, a leadership bench, and centralized operations. Many multi-office practices decide to build

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs The backbone of a great dental practice is a full hygiene schedule and getting paid at a fee for service rate. I’ve spoken with many dentists who accept bad paying PPOs and many attempt to renegotiate reimbursements. These dentists do prophies themselves because a hygienist costs $70 per hour but the PPO only pays $50. The dentist is now chained to an unending prophy hamster wheel, the con

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs You’ve heard it countless times: hygiene drives the practice. If your hygiene schedule isn’t full, your practice is leaking revenue—even if the doctor’s schedule is full. A thriving hygiene schedule stabilizes cash flow, fills the doctor’s schedule, identifies potential cases, supports case acceptance, and protects the practice’s value. A consistent hygiene schedule also fosters patient relat

Dental Associate Compensation Models By Spiro Leunes, CPA | CEO, MRL Advisory Group — New Jersey & New York Dental CPAs Dental associate compensation models must be optimally designed for the practice type (private practice versus DSO) and to properly incentivize the dental associate. A general dentist associate will only be differently than a specialist dental associate. Dental associate compensation falls into one of these models: Percentage of Collections The associate is

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs The dental profession is accelerating toward another major consolidation cycle, and far more dentists are selling to private equity–backed DSOs than forming their own organizations. But before any dentist considers selling, scaling, or staying independent, there is one universal truth for 2026: The dental profession is accelerating toward another major consolidation cycle, and far more dentis

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs If you are forming a Dental Support Organization or scaling into a multi-location dental group, the Management Services Agreement (MSA) is one of the most important documents you will ever sign. A properly structured MSA protects your clinical independence, reduces your tax burden, strengthens DSO EBITDA, and increases your long-term valuation. Keep the Clinical Side Completely Separate Corp

By Spiro Leunes, CPA | CEO, MRL Advisory Group — New Jersey & New York Dental CPAs Managing the financial side of a dental or medical practice can be overwhelming. Between patient care, staff management, and regulatory compliance, the last thing you want is to struggle with complex accounting and tax issues. That’s where specialized dental accounting solutions come in. These services are designed to help practices like yours optimize finances, reduce tax liabilities, and impr

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Introduction If you’re a dentist running a practice in 2025, you’re probably feeling the squeeze. Shrinking reimbursements, staffing shortages, rising costs, and patients pulling back on elective care are making it harder to keep margins healthy. Add in the growing influence of DSOs and the costs of adopting new technology, and it’s clear: this is a defining year for the business side of dent

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs In working with many dentists, I notice that many of their problems often comes down to not doing the basics. Here are just a few VERY common issues that make a huge difference in the success of a practice: 1. Collect payment prior to the patient leaving - Seems basic but I am surprised how many dentists let this happen. Very often it’s the front desk that lets this happen, but ultimate respo

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Private equity activity in dentistry is booming again in 2025 — are you ready to capitalize on it? Dental Service Organizations (DSOs) are attracting major private equity investment, but today’s deals look a lot different than they did just a few years ago. We’re seeing: More flexible deal structures with equity participation Growing interest in specialty dental practices A big push for AI an

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs The dental profession is undergoing one of its most significant shifts in decades. Where solo practices once dominated the landscape, today’s market is increasingly moving toward group practices—from dentist-led partnerships to multi-location operations and DSO-backed networks. This isn’t a temporary trend; it’s a structural transformation in how dentistry is practiced, managed, and monetized

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs The first quarter of 2025 offered a revealing snapshot into the evolving dental landscape in the United States. General practices, DSOs (Dental Support Organizations), and specialty providers such as orthodontists, oral surgeons, endodontists, and pediatric dentists experienced both tailwinds and challenges. While inflationary pressures and hiring shortages lingered, production remained stron

The Pros and Cons of A Subscription-Based Model for Dental Practices and DSOs By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs As the dental industry evolves, many practices and Dental Support Organizations (DSOs) are exploring new ways to enhance patient care while maintaining financial stability. One model that has gained popularity is the subscription-based model, often referred to as a dental membership plan. While this approach offers

S-Corporation vs. LLC: Which Structure is Best for Your Dental Practice? By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs When starting or restructuring your dental practice, one of the most important decisions you’ll make is choosing the right business structure. This decision impacts your taxes, liability protection, and day-to-day operations. Many dental practice owners choose between S-Corporations (S-Corps) and Limited Liability Compan

Building a DSO: A Guide for Young Dentists By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Expanding a dental practice into a Dental Service Organization (DSO) is an exciting opportunity for young dentists to scale operations, centralize non-clinical tasks, and improve efficiencies. Success requires strategic planning, compliance with legal and tax regulations, a robust marketing strategy, and building the right team. Additionally, the DSO

How Much Should Associate Dentists Be Paid? General Dentists vs. Specialists By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Determining the appropriate compensation for associate dentists is a crucial step for any growing dental practice. Compensation must reflect both market standards and the value an associate brings to the practice. This article explores how compensation differs between associate general dentists and associate special

Top Dental Trends to Watch in 2025 As the dental industry evolves, staying ahead of emerging trends can be the difference between thriving practices and those struggling to keep up. In 2025, dental professionals should focus on advancements and shifts in technology, patient expectations, and practice management strategies. Here are the top dental trends to watch for in the coming year: 1. The Rise of Artificial Intelligence in Dental Diagnostics Artificial intelligence (AI) i

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Whether you’re buying your first dental practice or selling a well-established one, the process can be both exciting and overwhelming. It’s a journey filled with financial decisions, legal requirements, due diligence, and emotional milestones. That’s where a dental practice broker becomes your most valuable ally. Let’s explore why using a dental practice broker is essential for a smooth and s

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs The success of a dental practice depends on delivering high-quality patient care and managing operational and financial metrics effectively. Key Performance Indicators (KPIs) provide insights into a practice’s health, enabling established dental practice owners to identify areas for improvement and align with industry standards. This blog examines national averages for critical KPIs, includin

Revolutionizing Dentistry: How AI Is Transforming Modern Dental Practices By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Artificial Intelligence (AI) is revolutionizing the dental profession, enhancing diagnostics, treatment planning, and patient outcomes while streamlining operations. AI’s ability to process data with precision and speed is helping dental practices provide exceptional care and operate more efficiently. Here’s how AI is i

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs The most effective dental practice consultants do more than just offer advice—they dive into the details, develop actionable strategies, and work closely with you to implement sustainable improvements. They understand the complexities of running a dental practice and leverage their expertise to help you optimize both clinical and business aspects of your practice. Below are specific strategie

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs When it comes to buying or selling a dental practice, the appraisal process is the foundation of a fair and successful transaction. A well-conducted appraisal not only establishes the value of the practice but also uncovers key insights into its financial health, operational efficiency, and growth potential. Whether you’re a buyer looking to invest wisely or a seller aiming to maximize your r

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Launching a startup dental practice is an ambitious yet rewarding endeavor. With startup costs often ranging from $700,000 to over $1 million, many dentists continue working as associates in other practices to ensure financial stability during the initial stages. Here’s a detailed guide to navigating this process, from securing funding to deciding when to transition fully into your new practi

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs In recent years, private equity (PE) investment in dental practices has surged, largely driven by the growth of Dental Support Organizations (DSOs). A private equity investor with a focus on the dental industry, may be asked: What makes a dental practice attractive to private equity? and How can a dentist prepare their practice for a successful acquisition? This blog post provides actionable

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs In the competitive world of dentistry, success is not just about providing excellent clinical care—it’s about building a thriving, patient-centered practice. At the heart of this success lies a robust dental hygiene department. Often considered the backbone of a dental practice, the hygiene department plays a pivotal role in patient care, retention, and the practice’s financial health. Here’s

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Starting your own dental practice is an exciting venture, but the first critical decision you’ll face is whether to buy an existing dental practice or build one from the ground up. Each option has its merits and challenges, and the right choice depends on your goals, resources, and vision. Let’s explore the advantages and disadvantages of both paths. Buying an Existing Dental Practice Advanta

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Running a successful dental or medical practice requires balancing exceptional patient care with sound financial management and getting back to basics. One often-overlooked aspect of this balance is the need to periodically review and adjust your fee schedule. While some practitioners might feel hesitant to increase fees, especially in a competitive market, it's crucial to recognize that regu

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs The dental industry is undergoing a transformative shift, with private equity-backed Dental Service Organizations (DSOs) driving consolidation and innovation. For dental practice owners, this presents a critical question: Is it better to sell to a private equity-backed DSO or grow the practice independently and potentially form your own DSO? Both paths offer unique advantages and challenges,

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs Unlocking Fair Compensation: A Guide for Dentists Renegotiating Fee Reimbursements with Dental Insurance Companies In the evolving landscape of dental practice management, dentists face the dual challenge of providing exceptional patient care while ensuring their practice remains financially sustainable. One critical aspect of this balance involves negotiating—or renegotiating—fee reimburseme