How Heartland Dental Reached 2,000 Offices: Its Doctor-First Deal Rubric
Heartland Dental grew toward 2,000 supported offices by screening every deal on the doctor first, then the facility, then the market, and only then the financials. Chief Growth Officer Mark Greenstein told Becker’s that if the doctor, facility or market fit isn’t there, a deal isn’t worth doing at any price. With 1,960+ practices and 3,200+ affiliated dentists at the time, Heartland had added 110+ offices in 13 months by pairing de novos in fast-growing, underserved markets like Florida, Texas, Tennessee and Arizona with affiliations in mature markets. Its 30+ location Foundation Dental Partners deal took 90+ days of prep and was run as office-by-office plans, with onboarding starting at HR, benefits and 401(k) before operating systems, followed by quarterly half-day doctor reviews.
Heartland became the first DSO to cross 2,000 supported offices on Oct. 21, 2026, and its playbook is less about capital than sequencing: qualify the doctor before the numbers, staff integration heavier than the deal team, and choose de novo vs. affiliation by market maturity. Any multi-site operator can borrow that filter.
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How does Heartland Dental decide which dental practices to affiliate with?
Heartland evaluates the doctor first, then the facility, then the local market, and reviews financials last. It looks for dentists who are committed, engaged in their community, strong in general dentistry and “open, positive and flexible.” Chief Growth Officer Mark Greenstein says that if the doctor, facility or market isn’t right, the deal isn’t worth it regardless of price.
Does Heartland Dental grow more through de novos or acquisitions?
Heartland runs both programs and does not favor one over the other. It opens de novos in fast-growing markets with few dental offices, such as Florida, Tennessee, Texas and Arizona, and affiliates with established practices in more mature markets. Across both, it added more than 110 practices in the 13 months before October 2026.
How does Heartland integrate a multi-location group it acquires?
Heartland treats a group deal as a set of individual deals; Greenstein called the 30-plus-office Foundation Dental Partners affiliation “a solo deal times 33.” Preparation ran more than 90 days with a support team several times the size of the deal team. Onboarding starts with HR systems, medical benefits and 401(k) plans before operating systems, and doctors then meet quarterly in half-day sessions to review goals and performance data.