North American Dental Group and Your Practice: What Owners Should Know in 2026
You own four offices. The letter that arrived this week is addressed to you as a group, not as a dentist.
Most owners skim past that. It is the whole story.
Some buyers in dentistry are built to absorb one office at a time. A smaller number can take an entire group in one piece, keep its signage, and put the person who built it into a leadership seat.
North American Dental Group is the second kind. Maybe you have decided your three or four sites fall into an awkward gap.
Too big for a simple tuck-in. Too small for anyone’s platform.
This profile is about the buyers who think the opposite.
Key takeaways
- NADG grows by group, not only by practice. Becker’s Dental Review describes it as operating a group affiliation model rather than a single-acquisition affiliation model.
- The scale is real. Its own site states more than 200 supported practices, over 400 dentists and 500 hygienists across 15 states, run from Pittsburgh.
- Local brands survive. NADG lists roughly 56 practice brands it supports, including several that joined years ago and still trade under their original names.
- A multi-site group is priced on a different logic than a single practice. What matters is how much profit survives your departure, not your chair count.
- Owning several locations widens your buyer list rather than narrowing it. That changes who you should be talking to before you answer anyone.
Does North American Dental Group buy existing dental practices? Yes, and it affiliates whole groups as well as individual offices. NADG is a Pittsburgh-based dental support organization supporting more than 200 practices across 15 states, owned by Jacobs Holding since 2019, and it brings founding doctors into leadership roles rather than retiring their brands.
Who North American Dental Group actually is
Founded in 2008. It began with one struggling office in Canfield, Ohio, where a dentist asked a friend with a commercial background to untangle the paperwork strangling him.
Becker’s and the company both tell that origin story.
Today NADG states on its own site that it supports more than 200 dental practices, over 400 dentists and more than 500 hygienists across 15 states. Becker’s and its owner’s portfolio page have published figures nearer 230 to 240 supported offices as the network shifted.
Headquarters: Pittsburgh, Pennsylvania.
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, the body of state law restricting who may own or control a dental practice.
NADG runs the split through the Professional Dental Alliance, a dentist-led entity, with an internal Oral Health Board steering clinical policy.
Ownership sits with Jacobs Holding, a Zurich investment firm, which bought NADG in 2019 from ABRY Partners and The Riverside Company. Jacobs also owns Colosseum Dental Group in Europe.
Trade coverage at the time called the combination the first transatlantic dental group.
One detail matters to a seller. The founders and dentist partners held onto meaningful stakes through the ownership handovers.
That is a different animal from an organization where every selling doctor was cashed out on day one.
Does NADG buy existing practices, or build new ones?
It buys. That has been the engine since the beginning.
The question matters more in dentistry than owners realise. Of the three largest DSOs in the country, only Heartland Dental is substantially acquisition-led.
Aspen Dental and PDS Health grow mainly by opening de novo offices, meaning brand-new locations built from scratch rather than existing practices purchased.
NADG sits firmly in the acquiring column. Becker’s has covered individual affiliations, including Park 56 Dental in Manhattan and a Manhattan pediatric group, alongside de novo openings and consolidations inside territories it already serves.
The wider pool stays busy too. Becker’s counted more than 130 DSO affiliations, openings and acquisitions nationally in the first part of 2026.
More than 70 landed in the first quarter alone. Sixty-nine percent of DSOs reported that their sponsors expect heavier acquisition activity this year.
So demand is not your constraint. Your process is.
The part that makes this buyer different
Here is the detail that should change how a multi-site owner reads their inbox.
In late 2020, NADG announced it had folded 18 dental offices across six states into its network at once. Not eighteen separate deals spread over a year. Seven distinct dental groups, in one wave.
The roster included Park 56 Dental in New York City, Snodgrass-King Dental across the Nashville area, Southeast Orthodontics in southeastern Massachusetts, AuraSmile Dental in Cleveland, a three-office cluster around Pensacola, and an oral and maxillofacial surgery practice in New York.
The principals were not retired. Each was installed under a title the company uses deliberately, Group Founder, with a stated remit to keep expanding their own vision in their own territory.
Here is the part that outlives the press release.
Open NADG’s brands page in 2026. Park 56 Dental, Snodgrass King Dental, Southeast Ortho and AuraSmile Dental are all still listed, among roughly 56 supported brands.
Six years on, the signage survived.
That is evidence, not a promise made across a conference table. If you are weighing what happens to a name you spent twenty years building, it is the most useful thing on this buyer’s public record.
Becker’s frames the strategy plainly, describing NADG as running a group affiliation model instead of a single-acquisition affiliation model.
Its chief executive has spoken about growth through expansion and joint ventures, and about keeping partner dentists engaged across a whole career rather than a three-year handover.
Read that as a seller and it says something precise. This buyer is built to absorb an organization, leadership layer included.
Not just charts and chairs.
What kind of practice or group NADG looks for
The footprint tells you most of it. Fifteen states, weighted toward the eastern and midwestern United States, arranged into regional territories rather than scattered nationally.
The brand list spans general dentistry, pediatrics, orthodontics, oral surgery and multi-specialty groups. Density inside a territory it already serves is clearly a priority.
When NADG merged two ageing Ohio offices into one new Bellaire location, that was the same logic in miniature.
No threshold is published. Nobody in this market publishes one.
Any number you are quoted for a named organization has been generalized from thin data.
Fit is what you can reason about. Three to eight offices, inside or beside a territory where the buyer already operates, led by a clinician who wants to keep leading.
That is the shape this model was built around.
How a multi-location group is valued differently
This is where owners of two, three or four locations leave the most money behind. It is entirely avoidable.
Start with the bridge. Dental owners think in collections.
Buyers think in profit.
Collections, minus true operating overhead, minus a market-rate associate’s pay for the dentistry you personally perform, gives you adjusted EBITDA. That figure, times a multiple, is enterprise value.
Watch the middle step. Suppose you produce $1.05 million a year yourself and a market-rate associate would earn roughly 30 percent of it.
Then about $315,000 of what feels like profit is actually your wages.
Take a worked case. Three offices.
Combined collections of $6.4 million. Operating costs of $4.93 million, near 77 percent.
That leaves $1.47 million before your own compensation. Subtract the $315,000.
You have adjusted EBITDA of roughly $1.155 million.
Now the question almost nobody asks early enough.
Sold one at a time to three separate local dentists, each office becomes a modest tuck-in carrying about $385,000 of earnings.
Across the market, a solo general practice bought as a tuck-in tends to trade around five to seven times adjusted EBITDA. Call it $5.8 million to $8.1 million altogether.
That is before three sets of legal bills and three closing calendars.
Sold as one group, the arithmetic shifts. A two-to-four-doctor group bought as a regional add-on tends to land nearer seven to nine times.
A five-to-nine-location regional group with a working management layer climbs higher again, often eight to eleven.
On the same $1.155 million, that gap is worth several million dollars. Identical dentistry.
The clinical work never changed. What changed is what the buyer believes it is purchasing.
There lies the point most owners miss. Pay a single-practice multiple and you have bought a profitable job.
Pay a group multiple and you have bought an organization that still functions while its founder is in Portugal.
So the real test is not how many addresses appear on your letterhead. It is how much of your earnings outlive your departure.
I have sat with an owner of four offices whose numbers priced like one. He personally produced 55 percent of collections at the flagship.
The other three sites were satellites held together by his mobile number.
That is not a group. It is a practice with outbuildings, and bidders price it that way.
I have also sat with an owner of two offices whose numbers priced like a small platform. She had a genuine practice manager, one shared front-office system, provider-level reporting, and a signed associate agreement at each site.
Two addresses. Group economics.
The difference is structural. Here is the encouraging bit: much of it can be repaired inside twelve to eighteen months, provided you begin before you go to market rather than midway through diligence.
Why the marketing package is a different document set
A single practice is marketed on a practice P&L, a production report and a chair count. A group is not.
A group buyer expects consolidated financials across every entity. Then a location-level profit and loss for each office.
Provider-level production and collections. A management organization chart.
A clean map of leases, entities and licences across all sites.
Miss any of those and diligence becomes archaeology. Every week of digging is a week in which enthusiasm cools and questions sharpen.
There is a second consequence. Group deals run longer.
The four-phase sequence law firms describe for a DSO transaction, from preparation through letter of intent and diligence to closing, stretches once there are five sets of books rather than one.
Plan the longer runway. Pay for the accounting work up front.
It is the cheapest money in the whole transaction.
What an offer typically contains
NADG does not publish a price sheet, and neither does any other organization in this market. What any buyer pays depends on the practice, the geography, their current appetite, their capital position, and above all on who else is bidding.
What holds broadly across the PE-backed pool, rather than for any one organization:
Cash at close is usually a portion of the headline figure, not the whole of it. Rollover equity, meaning a slice of ownership in the buyer’s company instead of all cash, often makes up part of the balance. Earnout may account for the remainder, paid later and only if agreed targets are hit after closing.
For a group seller there is a fourth ingredient that rarely appears in single-practice deals. A continuing leadership role, sometimes carrying its own compensation and its own equity, attached to the territory or the brand you built.
That is worth real money. It is also chronically under-negotiated, because owners treat it as a courtesy rather than as consideration.
So two offers with identical headline numbers can be worth wildly different amounts. How the price is allocated across asset classes drives your tax bill as well, which is why buyer and seller must report the same allocation.
What changes after the sale
NADG’s stated positioning is administrative support delivered through regional resource centres, with clinical direction sitting on the dentist-owned side via the Professional Dental Alliance and its Oral Health Board.
Its brands page is the strongest evidence available on signage. Local and regional names are the norm rather than the exception, and several have endured for years after affiliation.
As with any buyer, the pitch deck is not how you test the rest. A conversation is.
Specifically, with dentists who affiliated at least two years ago, long enough for integration to have happened and any honeymoon to have ended.
Terms genuinely worth pinning down in writing, at any buyer: which clinical decisions stay yours, your post-sale role and hours, what happens to your team’s jobs and pay, whether each practice name survives, and who your day-to-day contact becomes.
Group sellers should add one more. What becomes of your management layer.
The regional manager, the billing lead, the marketing coordinator. Those roles are the ones most likely to duplicate the buyer’s own.
Questions worth asking NADG specifically
Ask to speak with two Group Founders who affiliated at least two years ago. Not one.
Two, and not both hand-picked from the same territory.
Ask what decisions stayed theirs. Ask what their week looks like now against before.
Ask whether the promised support actually arrived, and how long it took.
A confident organization arranges that call quickly. Hesitation, or one carefully chosen referee, tells you something useful at no cost.
Then the group-specific questions. What happens to my brand names, and for how long?
Is that written into the agreement or merely intended? Who runs my territory after closing, and do they already oversee offices near me?
What does the Group Founder role involve in hours and authority? Is a joint venture structure available on future locations in my area, and on what terms?
Finally, the one that separates a real answer from a polished one. Which parts of my current management team do you intend to keep, and which functions migrate to your resource centres?
How to know whether the offer is competitive
Here is what actually decides your outcome, and it is not which organization you are talking to.
A buyer who approaches you directly is competing with nobody. Their offer reflects that, and it would be strange if it did not.
The same organization, bidding against three rivals who also want your group, behaves differently. Not because the first number was dishonest.
Because the leverage moved.
The pool runs deep enough for that to be real. ADSO counts more than 80 member companies supporting thousands of practices, and Becker’s has logged over 130 affiliations, openings and acquisitions in 2026 so far.
Multi-site sellers feel the effect harder, because several buyer types qualify at once. A regional platform filling a hole in its own footprint.
A larger organization hunting for your management layer. A group-affiliation buyer such as this one.
Each prizes a different part of what you own.
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 group, 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 multi-location seller this matters more than usual, because the gap between a tuck-in multiple and a group multiple is decided by whether anyone in the room has to compete for the whole thing.
What to do next
If an NADG approach is sitting in front of you, the first task is not measuring it against your expectations. It is working out whether your group is being priced as a group at all.
Document your adjusted EBITDA across every location, including the market-rate associate adjustment for your own production. Build the location-level profit and loss statements before anyone requests them.
Then answer one question honestly. How much of that profit still shows up in a month when you never set foot in the place?
Most of it? You are a group, and you should be marketed as one.
Under half? Then twelve to eighteen months of unglamorous repair work is available to you, and it is worth far more than any negotiation.
Practice ownership in dentistry has slid for two decades, from roughly 85 percent in 2005 to under 73 percent by 2023, with DSO affiliation climbing steadily alongside. That drift is why the buyer pool exists.
It is not a reason to rush.
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 North American Dental Group buy existing dental practices?
Yes. NADG affiliates existing practices and whole dental groups, and Becker’s Dental Review describes it as operating a group affiliation model rather than a single-acquisition model.
It also opens de novo offices and consolidates locations inside markets it already serves.
Who owns North American Dental Group?
Jacobs Holding, a Zurich-based investment firm, acquired NADG in 2019 from ABRY Partners and The Riverside Company. Jacobs also owns Colosseum Dental Group in Europe.
NADG’s founders and dentist partners retained meaningful stakes through the transaction.
How big is North American Dental Group?
Its own site states more than 200 supported practices, over 400 dentists and more than 500 hygienists across 15 states, headquartered in Pittsburgh. Becker’s and its owner’s portfolio page have reported figures in the 230 to 240 supported-office range.
Will my practice keep its name if I affiliate with NADG?
NADG lists roughly 56 practice brands it supports, and several that joined years ago still trade under their original names. Treat that as a strong starting point, then get the specific commitment and its duration written into the agreement rather than assumed.
Is a multi-location dental group worth more than the same practices sold separately?
Usually yes, sometimes substantially. Groups with a genuine management layer and earnings that survive the owner’s absence are priced on a higher multiple than a comparable single practice sold as a tuck-in.
Groups that depend on the owner’s personal production are not.
What is a Group Founder at NADG?
It is the leadership title NADG has given principals of groups it affiliates, with a stated role in continuing to expand in their own market. If it is offered to you, treat it as part of the consideration and negotiate it, not as a courtesy title.
What does NADG pay for a dental practice?
There is no published price sheet, and any specific multiple attached to a named organization is generalized from limited data. What any buyer pays depends on the group, the market, their current appetite and who else is bidding for it.
Should I accept a direct offer from NADG?
Not before other qualified buyers have looked at it. A multi-site group is eligible for several different buyer types at once, and each values a different part of what you own.
Without competition you have no way to know which value you were paid for.
Sources
North American Dental Group: scale, ownership and structure
- North American Dental Group. “North American Dental Group DSO.” nadentalgroup.com
- North American Dental Group. “Brands North American Dental Group Supports.” nadentalgroup.com
- Jacobs Capital. “North American Dental Group.” jacobscap.com
- Becker’s Dental Review. “Investment firm acquires North American Dental Group.” beckersdental.com
- Group Dentistry Now. “North American Dental Group To Be Acquired By Jacobs Holding.” groupdentistrynow.com
The group affiliation model and NADG’s growth strategy
- Becker’s Dental Review. “The strategy behind North American Dental Group — 3 notes from CEO Ken Cooper.” beckersdental.com
- Becker’s Dental Review. “The growth strategies of 5 DSOs.” beckersdental.com
- Group Dentistry Now. “DSO ‘Pioneering a New Culture in Dentistry’ Grows Stronger with Addition of Practices.” groupdentistrynow.com
- Becker’s Dental Review. “North American Dental Group adds New York City practice.” beckersdental.com
- Becker’s Dental Review. “52 DSOs to know: 2026.” beckersdental.com
Buyer pool, deal volume and market structure
- Becker’s Dental Review. “130 DSO affiliations so far in 2026: State-by-state breakdown.” beckersdental.com
- Becker’s Dental Review. “70+ DSO affiliations in Q1: State-by-state breakdown.” beckersdental.com
- Becker’s Dental Review. “69% of DSOs plan to boost acquisitions in 2026: Report.” beckersdental.com
- Becker’s Dental Review. “The largest DSOs headed into 2026.” beckersdental.com
- Association of Dental Support Organizations. “About ADSO.” theadso.org
Ownership trends and practice economics
- ADA Health Policy Institute. “Practice Ownership Trends in Dentistry: A New Look at Old Data.” ada.org
- ADA News. “Private equity affiliation among dentists increases.” adanews.ada.org
- ADA Health Policy Institute. “The State of the U.S. Dental Economy, Q1 2026 Update.” ada.org
Deal structure, process 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.
