Great Expressions and Your Practice: What Owners Should Know in 2026
The letter says they already have offices near you. Most owners read that as a threat.
It is usually the opposite. When a buyer already runs thirty offices inside your metro, your practice is worth more to them than it is to a national group adding a pin to a map.
Not because they like you better. Because the arithmetic on their side is genuinely different.
Great Expressions Dental Centers is the clearest example of that in the Midwest and along the East Coast. Roughly 250 practices.
About nine states. Here is what that concentration actually means when the approach lands on your desk.
Key takeaways
- Great Expressions is dense, not broad. Roughly 250 practices across about nine states, anchored in Michigan and Ohio and running through Georgia, Florida, the Northeast and the Mid-Atlantic.
- Its acquisition record is almost entirely in-footprint. Detroit, Cleveland, Akron, Atlanta, Savannah, Massachusetts, Long Island. It deepens markets it already runs rather than planting flags in new ones.
- Density changes what a practice is worth to a buyer. Shared hygiene coverage, marketing that already reaches your patients, and referrals that stay inside the group all land in the same place: a higher run-rate number.
- Backed by Roark Capital Group since 2016, its third institutional sponsor since the practice group was founded in 1982.
- Being in a dense buyer’s footprint is a reason to run a process, not skip one. You cannot tell what your market premium is worth until more than one buyer bids for it.
Does Great Expressions Dental Centers buy existing practices? Yes. It has grown substantially by affiliating with independent practices and groups, and its announced deals sit almost entirely inside markets it already serves.
Founded in 1982 and based in Southfield, Michigan, it supports roughly 250 practices across about nine states, backed by Roark Capital Group.
Who Great Expressions actually is
Founded in 1982. Headquartered in Southfield, Michigan, just outside Detroit.
Becker’s Dental Review puts it at roughly 250 practices across about nine states in its 2026 roster of DSOs to know.
A DSO is a dental support organization: the management company owns the non-clinical side of a practice and handles everything outside the operatory, while a licensed dentist keeps ownership of the clinical entity. That split exists because of the corporate practice of dentistry doctrine.
Those are the state laws restricting who may own or control a dental practice.
Great Expressions runs that structure openly. Its branded practices are independently owned and operated by licensed dentists in each state, while an affiliated management entity provides the administrative and support services and licenses the brand name.
The footprint runs from Michigan and Ohio through New York, New Jersey, Connecticut and Massachusetts, then down through Virginia, Georgia and Florida, with a Texas presence as well. Concentrated, and organized around metros.
Roark Capital Group has owned it since September 2016, when Roark acquired the group from OMERS Private Equity. At the time of that transaction Great Expressions supported around 269 affiliated practices, staffed by more than 900 dentists and hygienists, treating over 600,000 patients a year.
That is a long institutional history. OMERS before Roark, Audax before OMERS.
Forty-plus years of operating and three sponsors is not a startup platform assembling itself in real time.
Does Great Expressions buy existing practices, or build new ones?
It buys. And the pattern in what it buys is the interesting part.
Look at the announced affiliations rather than the corporate language. In October 2021 it affiliated with Pure Health Dental, an Ohio group with practices in the greater Cleveland and Akron markets.
Ohio was already Great Expressions territory.
Two months later, in December 2021, it affiliated with Amazing Dental Group. Four locations across metro Detroit.
Twenty-eight dentists and hygienists. Founded in Wyandotte, Michigan in 2018.
Metro Detroit is where the head office sits.
In October 2022 it affiliated with Ascent Dental Care in Massachusetts, with founder Dr. Kevin Coughlin staying on to lead it.
Massachusetts was already in the footprint.
Earlier deals follow the same shape. A 16-office affiliation across Atlanta and Savannah, sitting alongside 35 offices the group already ran in that region.
A Long Island affiliation in New York. A Westland affiliation in Michigan.
I cannot find a single announced deal where the point was to enter a state they were not already in.
That is a strategy, and it is worth naming plainly. Great Expressions grows by getting denser where it already is.
If your practice sits inside one of its markets, you are the target profile. If you are three states outside it, you are probably not, no matter how good your numbers are.
Why 250 practices in nine states is not the same as 250 in forty
Here is the thing most owners never get told, and it is the single most useful thing to understand about a buyer like this.
Practice count is a vanity number. What determines how much of your profit a buyer can actually keep is how many other offices they run within driving distance of yours.
Think about what a buyer inherits when they acquire you. Your staff.
Your marketing spend. Your lab bills.
Your insurance verification. Your specialty referrals walking out the door.
Every one of those lines behaves differently depending on whether the buyer has one office in your state or thirty in your county.
Staffing is the biggest one. The ADA Health Policy Institute reports that only around 60% of dentists say they have adequate hygiene staffing, and among those actively recruiting a hygienist, more than nine in ten call it very or extremely challenging. That has held steady for three years.
Now picture two buyers facing the same open hygiene chair on a Tuesday. The buyer with 28 offices inside an hour moves someone.
The buyer whose nearest office is 300 miles away calls a temp agency and pays the premium. Same practice, two very different overhead lines.
Marketing is the second. Local dental advertising is bought by market. A metro paid-search footprint.
A radio buy. Direct mail across a cluster of ZIP codes.
The cost of blanketing a metro barely moves whether you have three offices in it or thirty.
Your own promotional budget is probably running somewhere between two and five cents of every dollar you collect. A dense acquirer absorbs most of that into spend it is already committed to.
Referrals are the third, and the most overlooked. Every implant case, every impacted third molar, every complex endo you send out is production leaving the group. A buyer with an oral surgeon fifteen minutes away keeps a meaningful share of it inside.
A buyer without one in your state keeps none of it.
Then there is the unglamorous layer. Regional management that already drives past your door.
Insurance contracting negotiated at the state level, where PPO leverage is actually won. A recruiting pipeline where an associate can be offered a career path across a dozen offices without moving house.
None of this is a favour to you. It is why the same practice can be worth materially more to one buyer than another, and why the buyer with the biggest brand is frequently not the one with the biggest number.
What density is actually worth, in numbers
Abstractions are easy to nod along to. Let me put real arithmetic on it.
Take a two-location general practice collecting $3.2 million. The owner produces $1.1 million of that personally.
True operating overhead runs $2.35 million. That is wages, supplies, lab, occupancy, advertising and administration.
That leaves $850,000 before the owner is paid for their own chair time.
Now pay a market-rate associate 30% on the owner’s production. That is $330,000.
You land on adjusted EBITDA of $520,000, which is what the practice earns after paying a market-rate dentist to do the work the owner currently does.
Now run the same practice past two different buyers.
Buyer A is national. Their closest office is 300 miles away. What they can genuinely take out is group supply and lab pricing, call it $30,000, and centralized insurance verification and billing, call it $25,000.
Run-rate EBITDA in their model: $575,000.
Buyer B already runs 28 offices within an hour. They get the same $55,000 first.
Then the practice’s $95,000 local advertising budget folds into a metro campaign already running for 28 offices. Roughly $65,000 of it disappears.
A regional hygiene float pool replaces the temp agency line, worth about $22,000. An in-network oral surgeon fifteen minutes away retains surgical production currently referred out, worth maybe $18,000 in margin.
Run-rate EBITDA in their model: $680,000.
Same practice. Same books.
Same day.
Apply the same multiple to both. Say 8×.
Buyer A lands at $4.6 million. Buyer B lands at $5.44 million. A gap of $840,000, and neither one has been generous or stingy. They simply own different amounts of the upside.
Two things follow from that, and both matter more than the example itself.
The first is that a buyer’s model is not a fixed fact about your practice. It is a fact about them.
Which means shopping the practice is not haggling. It is finding the party for whom the arithmetic is best.
The second is less comfortable. Density cuts both ways.
If a dense buyer already has three offices inside your five-mile radius, some of what you would sell them they arguably already have. Their appetite may be lower than you expect.
You cannot know which side of that line you fall on from the outside. A process is what reveals it.
What kind of practice Great Expressions looks for
Their public materials describe seeking affiliations with both group practices and single practices, and their record shows both. The Atlanta deal was 16 offices.
Amazing Dental Group was four. Suffolk Dental Center on Long Island was one location with a thirty-year history.
Reading the announced deals, three things recur.
An established patient base with a real operating history, often stretching back decades. Founders who stay on rather than leave immediately.
Dr. Coughlin remained at Ascent.
The Amazing Dental Group founders stepped into leadership roles after affiliating. And geography inside the existing footprint, every single time.
The group runs a broad clinical mix, including general, preventive, orthodontic, specialty and cosmetic services, which suggests multi-specialty practices sit comfortably inside the model rather than awkwardly.
Worth knowing separately. Great Expressions has run a Partner Doctor program since 2014, when 46 doctors became its first partners.
It lets participating doctors invest in the organization and share in its growth. That is a different thing from selling a practice.
It does tell you how the group thinks about doctor ownership.
What an offer typically contains
No organization in this market publishes a price sheet, and Great Expressions is no exception. What any buyer pays depends on the practice, the market, their current appetite, their capital position, and above all on who else is bidding.
A source quoting you a specific multiple for a named buyer is generalizing from very thin data.
What holds broadly across the private-equity-backed pool, rather than for any one group:
Cash at close is typically a portion of the headline figure rather than all of it. Rollover equity often makes up part of the balance. That means keeping a slice of ownership in the buyer’s company instead of taking all cash.
An earnout may make up the rest. That is part of the price paid later, and only if agreed targets are met after closing.
Two offers with identical headline numbers can therefore be worth very different amounts. The structure is where the difference hides, and it is negotiable far more often than owners assume.
The transaction itself runs in phases. An approach, a letter of intent, diligence, then definitive documents.
Counsel who write about the process describe four distinct stages.
Your leverage drops sharply the moment you sign the letter of intent. That is when your alternatives need to be in hand already, not when you start looking for them.
What changes after the sale
Practices affiliating with Great Expressions generally take the Great Expressions name. This is a single-brand group by design and has been since the 1980s, unlike the multi-brand platforms that keep local names intact.
For some owners that is fine or even welcome. For others, a name over the door with forty years of family history attached is not a small thing.
It is worth deciding how you feel about that before the conversation gets to price, because it is very hard to renegotiate afterwards.
Administrative and operational functions shift to the support organization. Billing, insurance, hiring, purchasing, advertising, technology.
The group moves quickly on that layer. It rolled an AI diagnostic platform across more than 210 offices in a two-week deployment.
Clinical decisions stay with licensed dentists. That is not a policy choice, it is the legal structure of every DSO in the country.
What that means in practice varies enormously, and the pitch will not tell you. The written agreement will.
Questions worth asking Great Expressions specifically
Generic questions get generic answers. These are the ones shaped by what this buyer actually is.
How many offices do you already run within thirty minutes of mine? This is the density question, asked directly. The answer tells you whether you are filling a gap or adding to saturation, and those are very different negotiating positions.
Which of my costs go away in your model, and which stay? A dense buyer should answer this line by line. Advertising, hygiene coverage, billing, supplies.
Vagueness here usually means the saving is smaller than the pitch implies.
Where do my specialty referrals go after closing? If they stay in the group, that production is now part of what they are buying. Say so out loud during the negotiation rather than after it.
Who is my day-to-day contact, and how many other offices do they cover? Regional management quality is the thing former owners talk about most, and almost nobody asks about it beforehand.
Can I speak with two dentists who affiliated with you at least two years ago, in my state? Two years is long enough for integration to have happened and any honeymoon to have ended. In-state matters, because the experience is regional.
A confident organization sets that call up quickly. Hesitation, or a single carefully selected reference, tells you something useful at no cost to you.
Get the specifics in writing: which clinical decisions remain yours, your post-sale role and hours, what happens to your team’s roles and pay, the brand transition timeline, and who you call when something goes wrong.
How to know whether their offer is competitive
Here is what actually decides your outcome, and it is not which group is sitting across the table.
A buyer who approaches you directly is competing with nobody. Their opening number reflects that, and it would be odd if it did not.
The same firm, bidding against three rivals who also want your practice, behaves differently. Not because the first number was dishonest.
Because the leverage changed.
The pool is deep enough for that to be real. Becker’s Dental Review tracked more than 200 DSO affiliations across the US in 2025, and reported that 69% of DSOs expect increased acquisition activity in 2026.
Roughly 30 to 35 organizations acquire independent general practices at meaningful scale.
Deal activity is also lumpy by state, which is exactly the point about density. Becker’s state-by-state tracking keeps showing the same handful of states absorbing a disproportionate share of affiliations.
California, Texas, Florida, Pennsylvania, New York. The mix shifts every quarter.
And in-footprint regional buyers frequently outbid national ones inside their own territory. Filling a gap in a market they already run delivers density.
A scattered national addition delivers a location.
Creating that competition is what the Elite Selling System exists to do.
We hand-select and vet every buyer who gets to bid on your practice, the way a doorman with a velvet rope lets in only the right people, then run a private competitive window inside that group.
With a dense in-footprint buyer this matters more than usual, because the premium they can pay is real but invisible. You only see it when someone else is bidding against them for the same territory.
What to do next
If a Great Expressions approach is on your desk, resist the urge to compare it to a number you heard at a study club.
Do three things instead. Get your adjusted EBITDA documented properly, with the bridge from collections shown line by line.
Find out how many offices the buyer already runs inside your metro. Then find out what your practice attracts when several qualified organizations are competing for it.
Great Expressions may well be the right home. A forty-year operating history, in-state management, and a genuine density advantage in your market are real assets, and plenty of owners have chosen exactly that.
The point is to choose it against alternatives rather than in the absence of them.
We will give you that assessment free and in confidence, including the answer that you should wait and fix a few things first when that is the honest one. It starts with a free, confidential practice value estimate.
Our fee varies depending on the value of the practice and is entirely success-based. If we do not get you a result, we do not get paid.
Frequently asked questions
Does Great Expressions Dental Centers buy dental practices?
Yes. It has grown substantially by affiliating with independent practices and groups, including Amazing Dental Group in metro Detroit, Pure Health Dental in Ohio, Ascent Dental Care in Massachusetts, and a 16-office affiliation across Atlanta and Savannah.
How big is Great Expressions, and where does it operate?
Becker’s Dental Review lists it at roughly 250 practices across about nine states in 2026. The footprint runs from Michigan and Ohio through the Northeast and Mid-Atlantic down to Georgia and Florida, with a Texas presence.
It was founded in 1982 and is based in Southfield, Michigan.
Who owns Great Expressions Dental Centers?
Roark Capital Group, which acquired the group in September 2016 from OMERS Private Equity. At that time Great Expressions supported around 269 affiliated practices with more than 900 dentists and hygienists, treating over 600,000 patients a year.
Why does a buyer’s geographic density matter to me as a seller?
Because it changes how much of your practice’s profit the buyer can actually keep. Shared hygiene coverage, metro marketing that already reaches your patients, in-network specialty referrals and regional management all raise the run-rate number a dense in-footprint buyer can justify.
Will my practice keep its name if I affiliate with Great Expressions?
Great Expressions has operated as a single brand since 1982, so affiliated practices generally take the Great Expressions name. If keeping your practice name matters to you, raise it early.
Reopening that point once price is agreed is far harder.
What does Great Expressions pay for a practice?
There is no published price sheet, and any specific multiple attached to a named buyer is generalized from limited data. What any organization pays depends on the practice, the market, its current appetite, and who else is bidding.
Should I accept a direct approach without talking to anyone else?
Not before other qualified buyers have looked at it. A direct approach is by definition uncontested, and with an in-footprint buyer you cannot tell whether their density premium has been priced in until someone else bids.
Is a regional buyer better than a national one?
Neither is better in general. A regional buyer with real density in your market can often justify more than a national group adding a scattered location, but that only holds where they actually have depth.
The way to find out is to let both look.
Sources
Great Expressions: scale, ownership and history
- Becker’s Dental Review. “52 DSOs to know: 2026.” beckersdental.com
- Roark Capital Group. “Roark Acquires Great Expressions Dental Centers.” roarkcapital.com
- Great Expressions Dental Centers. “Roark Acquires Great Expressions Dental Centers.” greatexpressions.com
- Great Expressions Dental Centers. “OMERS Private Equity Acquires Great Expressions.” greatexpressions.com
- Becker’s Dental Review. “Great Expressions Dental Centers adds VideaHealth AI platform.” beckersdental.com
The in-footprint affiliation record
- Great Expressions Dental Centers. “Great Expressions Dental Centers Affiliates With Amazing Dental Group.” greatexpressions.com
- Group Dentistry Now. “Pure Health Dental Partners Affiliates With Great Expressions Dental Centers.” groupdentistrynow.com
- DrBicuspid. “DSO Great Expressions affiliates with Ascent practices.” drbicuspid.com
- Great Expressions Dental Centers. “Great Expressions Continues Growth in Atlanta with 16 Office Affiliation.” greatexpressions.com
- Great Expressions Dental Centers. “Great Expressions Continues Growth in Michigan with Westland Affiliation.” greatexpressions.com
- Great Expressions Dental Centers. “Great Expressions Affiliates with Suffolk Dental Center.” greatexpressions.com
- Great Expressions Dental Centers. “Great Expressions Inducts First Group of Dentists into Partner Doctor Program.” greatexpressions.com
Buyer pool, deal volume and the geography of deals
- Becker’s Dental Review. “200+ DSO affiliations in 2025: State-by-state breakdown.” beckersdental.com
- Becker’s Dental Review. “Top battleground states for DSOs in 2025.” beckersdental.com
- Becker’s Dental Review. “16% of US dentists affiliated with a DSO: State-by-state breakdown.” beckersdental.com
- Becker’s Dental Review. “69% of DSOs plan to boost acquisitions in 2026: Report.” beckersdental.com
Practice economics, staffing and ownership trends
- ADA Health Policy Institute. “Dental Hygienist Shortage.” ada.org
- ADA Health Policy Institute. “Practice Ownership Trends in Dentistry: A New Look at Old Data.” ada.org
Deal structure and regulation
- Mandelbaum Barrett PC. “The Four-Phase DSO Transaction Process.” mblawfirm.com
- Cranfill Sumner LLP. “Selling Your Dental Practice to a DSO.” cshlaw.com
- US House Committee on Oversight. “Survey of State Laws Governing the Corporate Practice of Dentistry.” oversight.house.gov
Melani Seymour, co-founder of Transitions Elite, helps veterinary practice owners take action now to maximize value and secure their future.
With over 15 years of experience guiding thousands of owners, she knows exactly what it takes to achieve the best outcome.
