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Expanding a dental practice can mean opening another office, joining a group or shared-services arrangement, integrating with medical care, partnering with a safety-net provider, or reaching patients through teledentistry. The right path depends on the target community, ownership structure, services, staffing, state rules, and payer arrangements. Before committing, define the patient need and test the operating and regulatory requirements for that specific market.
What counts as a new healthcare market?
A new market is not necessarily a new ZIP code. It may be a different patient population, care setting, or delivery model. A practice opening a second location faces different decisions from one offering virtual consultations across state lines or coordinating care inside a community health center.
Start by describing the proposed market in practical terms: who needs care, where they are located, which services are missing or hard to access, and how patients will reach in-person follow-up. Define the service mix and whether the practice will own the operation, share nonclinical services, work with a health system, or partner with a safety-net organization. Those choices determine which legal, staffing, technology, and payer questions need answers.
Which expansion model fits the practice?
The American Dental Association (ADA) describes several possible practice arrangements. These are models to evaluate, not guarantees that a structure is permitted or suitable in a particular state.
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| Model | Ownership and operating arrangement | What it may make possible |
|---|---|---|
| Additional owner-operated location | The practice establishes another physical office; ownership and control remain with the practice. | A local in-person site for a new geographic area. The practice must plan for location-specific staffing, operations, and patient access. |
| Group practice | Dentists practice in a group arrangement, which may be independent or supported. | A shared practice structure for serving a patient base across providers or locations. |
| Shared-services cooperative | Dentists may retain practice ownership while centralizing nonclinical functions. | Shared administrative support without necessarily transferring clinical practice ownership. |
| Medical-dental model or health-system integration | Physician and dentist practices may be combined or coordinated; arrangements may include shared records, health-system employment, and referral relationships. | Closer coordination with medical care and potential access to established referral and care-coordination workflows. |
| Federally Qualified Health Center (FQHC) setting | Dental care is provided within a safety-net organization; FQHCs are often integrated medical facilities with a shared patient chart. | A setting for serving community needs in coordination with medical services. |
| Teledentistry or hybrid care | Care is delivered through synchronous live video, asynchronous store-and-forward, or a combination with in-person services. | Remote access or triage where the clinical need, technology, state rules, and local follow-up resources support it. |
Compare the options against the same decision criteria before choosing:
- Ownership and control: Who owns the practice, controls clinical decisions, and is responsible for nonclinical operations?
- Patient access: Does the model reach the intended population, fit its geography and insurance mix, and provide a workable route to in-person care when needed?
- Clinical coordination: Are referrals, shared records, and connections to medical, pharmacy, specialty, or behavioral-health services part of the model?
- Workforce: Can the practice recruit, train, supervise, and retain the staff needed across locations or virtual workflows?
- Administration and economics: What investment, payer mix, reimbursement processes, enrollment work, and performance data would the operation require?
- Regulatory feasibility: What do state licensure, scope-of-practice, supervision, privacy, payer, and patient follow-up rules require?
How should a practice assess the opportunity before investing?
Build the decision around a defined community and service plan rather than a generic expansion forecast. The available ADA practice-model and Medicaid pilot materials do not establish a broadly applicable cost, revenue, payback period, or market-size figure for expansion. A financial model therefore needs assumptions specific to the target area and proposed operation.
- Specify the market. Identify the patient group, geography or care setting, services to be offered, and access problem the expansion is intended to address.
- Choose candidate models. Compare a physical site, group or shared-services arrangement, integration with a health system, an FQHC partnership, and a virtual or hybrid workflow where relevant.
- Confirm local requirements. Ask the relevant state dental board and other appropriate authorities about licensure, scope, supervision, and any requirements tied to the proposed ownership or service model.
- Validate payer and operating assumptions. Check enrollment, coverage, coding, documentation, claims, staffing, technology, and follow-up needs for the target market.
- Set measures before launch. Track operational and patient-access measures that match the goal, such as enrollment progress, appointment availability, completed visits, follow-up arrangements, and claims outcomes.
Do not treat another state’s experience or a national estimate as a substitute for local assumptions. A credible projection should state its geography, service mix, ownership structure, payer assumptions, staffing plan, and the data used.
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Teledentistry can extend a practice’s reach, but it is not simply a video call added to the schedule. The U.S. Department of Health and Human Services (HHS) oral-health implementation guide, last updated August 6, 2024, describes both live video and asynchronous store-and-forward care, along with technology, workflow, security, and training considerations.
Select technology around the care task
Possible components include secure video-conferencing software, a capable computer, camera, microphone and speakers, tablet or smartphone, electronic health record (EHR) integration, and, where clinically useful, a handheld intraoral camera. HHS also identifies digital scanners as a possible technology component. These are options, not a universal equipment list. Evaluate image quality, clinical need, system compatibility, privacy controls, connectivity, and how the equipment fits the planned workflow. A handheld intraoral camera is a product category to consider for some examinations, not a required purchase or a specific model recommendation.
Design the complete patient workflow
Plan for scheduling, patient education, the remote visit, documentation, billing, follow-up, and contingencies for poor connectivity or a failed connection. Train staff on the selected tools and define how information will enter the patient record. Decide in advance what happens when a remote examination does not provide enough information or when a patient needs local in-person care.
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Keep clinical quality and follow-up central
The ADA’s teledentistry policy, updated in 2020, says remote examinations and interventions should be consistent with in-person care and supported by enough information for diagnosis and treatment planning. The dentist remains responsible for quality and documentation, should provide a service summary, and should know what local dental resources are available for follow-up. Remote delivery does not expand the scope of practice permitted for auxiliary personnel. The policy states: “The delivery of services via teledentistry must comply with the state’s scope of practice laws, regulations or rules.”
How do cross-state licensure rules affect expansion?
For remote care, the patient’s location matters. HHS’s general telehealth guidance, last updated April 30, 2025, describes potential cross-state pathways for healthcare providers: a full license, a temporary-practice or reciprocity provision, an applicable interstate compact, or telehealth registration where available. Those general pathways do not establish which one applies to a dentist in a specific state.
Before scheduling patients across a state line, verify that state’s dental-board requirements, scope-of-practice rules, and the applicability of any licensing pathway to the dentist and services involved. Confirm the patient’s location and obtain consent before the appointment, as HHS advises. Do not assume that a license or exception in the dentist’s home state authorizes care for a patient located elsewhere.
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Compact participation is also time-sensitive. An ADA Health Policy Institute article from April 2026 reported that 12 states had passed legislation to join the dentist and dental-hygienist licensure compact, with legislation pending in another eight at that time. That is a dated legislative snapshot, not confirmation of current availability or of an individual dentist’s eligibility. Check the compact and relevant state dental boards for current status.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.How should a practice evaluate reimbursement and Medicaid?
Reimbursement is a market-specific operating question, particularly for teledentistry. HHS says Medicaid teledentistry policies vary by state and advises checking private coverage with the patient’s insurer. Its guide was last updated August 6, 2024, so it is implementation guidance rather than a current determination for a specific payer or claim.
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Before launching a service, verify with each relevant payer:
- Whether the service is covered and under what conditions.
- Which codes and modifiers apply, and whether any specific provider or setting requirements apply.
- What documentation must support the service and claim.
- How to submit claims, monitor their status, and handle denials.
The ADA’s policy calls for dental benefit plans and public and private payers to cover covered teledentistry services to the same extent and level as in-person services when providers meet the policy’s conditions. This is the ADA’s policy position; it is not a uniform legal entitlement or a guarantee of payment under a particular state program, plan, or contract. Confirm actual terms directly with the relevant payer.
Treat Medicaid participation as an operational project
Medicaid entry involves more than deciding whether reimbursement fits the business plan. In a June 2026 summary of a two-year pilot that began in 2023 in Maryland, Nebraska, Ohio, Pennsylvania, Rhode Island, and South Dakota, the ADA reported that four of the six participating states increased dentist participation in Medicaid and expanded dental-service utilization. That bounded pilot result is not a forecast of what will happen in another state.
The ADA summary highlights provider outreach and education, enrollment assistance, simpler administrative processes, collaboration among stakeholders, and reliable data. It also reproduces the report authors’ statement: “Reimbursement increases should be paired with provider outreach and education to help combat outdated information or long-held beliefs about participating in the program.” For a new market, assess the full enrollment and claims workload alongside reimbursement, and identify who will own provider enrollment, staff support, and performance tracking.
What should be in a market-entry checklist?
Use a launch checklist that joins clinical, regulatory, technical, and administrative work. Assign an owner and a completion date to each item before opening a location or offering services to patients in a new jurisdiction.
- Market and care model: Define the population, unmet access need, service mix, physical or virtual setting, ownership, and any local care partners.
- Licensure and scope: Obtain state-specific confirmation of dentist and staff requirements, supervision rules, telehealth permissions, and any applicable compact or registration pathway.
- Patient safety and continuity: Set documentation standards, consent and location-verification steps for remote visits, escalation procedures, service summaries, and local follow-up options.
- Technology and security: Choose tools suited to the care task; verify connectivity, EHR workflow, security controls, staff training, and backup procedures.
- Payers and administration: Confirm enrollment, coverage, codes, modifiers, documentation, claim submission, denial handling, and claims tracking with each relevant payer.
- Workforce and partners: Plan recruitment, training, supervision, referrals, health-system coordination, or community organization relationships as the chosen model requires.
- Measurement: Define how to monitor access, utilization, enrollment, workflow performance, follow-up, and claims so the practice can adjust using local evidence.
How to make the expansion decision
Choose the model that fits the specific patient need and can meet its state, clinical, staffing, technology, and payer requirements. A second office, an integrated care arrangement, an FQHC partnership, and teledentistry solve different access problems; none is a universal shortcut. Proceed only when the target market’s rules and operating assumptions are concrete enough to support a practice-specific plan.
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