Improving DSO and Dental Due Diligence with AI

A long-time DSO industry thought leader and serial entrepreneur discusses his nontraditional career journey, what is broken in dental acquisition due diligence, and how to fix it.

DSOPro: Tell us how you got into dentistry.

Without modern medicine I likely would have died twice by the time I was 12 years old. After my second serious emergency surgery and hospitalization, I knew that I wanted to heal people and make people’s lives better. The magical ability of caring, skilled practitioners to relieve pain and heal after my long hospital stays inspired me to my calling in healthcare. Initially, I wanted to go to medical school and become a surgeon; however, after several discussions in college with medical doctors who were disillusioned with their profession due to the rise of managed care/HMOs, I decided to explore dentistry. After shadowing my family dentist one summer, I set my sights on dental school and never looked back. It was one of the best decisions I have ever made.

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Throughout dental school, I was focused on becoming the best dentist I could be with little thought to how I might practice in the future. Up to that point, I had only planned on going “the traditional route,” working as an associate for a few years before buying out a retiring dentist to become an owner, and practice dentistry for the remainder of my career. Attending dental school at Southern Illinois University, the closest dental school to Heartland Dental Care (HDC), turned out to be another pivotal decision that led me to a career in DSOs. When HDC hired a large portion of my class in 2004, group dentistry showed up on my radar. I was an early adopter of the belief that DSOs were the future, and now in 2022, I often joke that I have been working in DSOs since before DSO was an acronym!

DSOPro: How did you make the jump from clinical dentist to private equity-backed CEO?

Once I hit the “real world” as a practicing dentist, I quickly discovered that my passion and unique abilities were centered on the business of dentistry. I rabidly consumed everything I could get my hands on related to business and management, with as much focus on learning the ins and outs of the dental and healthcare businesses as possible. After pitching my first set of dental partners (not far into my first year as a dentist) on building a better dental group, I set out on my journey as a DSO leader. Finding myself inexperienced but with a clear vision of what I was trying to build, I simultaneously bought my initial partners out and began work on an MBA in Healthcare Management. I had the rare opportunity to run my DSO as an active student and simultaneously apply the concepts I was learning in my graduate work. This unique situation, coupled with an insane amount of grinding hours, resulted in explosive growth over a 2-year period, culminating in being named the #550th fastest growing business in the United States by Inc. Magazine in 2013 (the first of three consecutive Inc. awards). The Inc. award propelled my company into the status of a coveted platform target for private equity (PE) and large strategic dental investors. That same year, I also completed an extremely atypical PE transaction by today’s standards, where I was almost completely bought out and did not retain significant equity in my DSO. I am so grateful for this first experience because it was my introduction to the investor side of healthcare, where I’ve spent most of my time over the past decade.

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DSOPro: Tell us about your decision to take a career sabbatical and how that led to what you are doing now.

By this time, I was in my mid-30s, and I had exceeded every career goal I had set for myself less than a decade previously. I began asking myself some serious questions: What should I do now? Should I retire and ride off into the sunset? Should I build another DSO? Is there something else out there that will capture my attention? Should I try to make the PGA tour? I truly didn’t know. For the first time in my adult life, I decided to slow down. It was a precious gift to stop everything and step away for an indeterminate amount of time. I decided to use the sabbatical to disconnect, spend time with my family, and ponder retirement or what I might do as an encore.

I stepped completely away from my career for 18 months and spent 12 months of that time circumnavigating the globe with my family. We visited 6 continents and 35 countries while homeschooling our three boys, with only what we could carry on our backs. This time completely changed my career trajectory as I spent a large portion of the end of our “Round the World” year in a Starbucks in the Miraflores section of Lima, Peru. Alone and recovering from severe altitude sickness and pneumonia, I built a business plan and website for The DSO Project—dentistry’s first DSO accelerator. On the heels of DSOP’s successful launch, I started a new company called Dental Capital Partners. This company is a different kind of dental-focused M&A advisory firm, built by someone who has worn all the hats on all sides of the table in a PE transaction and post-transaction—me.

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These companies have helped me to continue to work with high-potential entrepreneurs and investors, while allowing me to play a key part in the inception phase of many DSOs, and also through a successful PE transaction with several iconic DSOs. My focus has been completely consistent for the last 20 years: to figure out how to learn from the past and disruptively innovate the future in dentistry while creating win-win-win situations for patients, doctors/teams, and communities/investors. This focus has created many personally rewarding instances of helping others achieve their goals and dreams.

Like many of us, the past several years have meant dealing with the disruptions of the Covid-19 pandemic, and like many of us, this opportunity created more time and free space to again consider my future. After 20 years in dentistry, I have felt the itch to diversify into adjacent healthcare verticals and also pivot into how to leverage technology to solve issues faced every day by DSOs and dentists in general. As a result, I was able to launch three new companies during the pandemic:

  • Creating a highly investable multi-specialty platform DSO with 80+ locations and a current valuation well into the nine digits, in about a year, built with my long-time business partner Ian McNickle.
  • An infrastructure business outside of dentistry that came close to eight-digit revenue in year one.
  • SmartDiligence.ai—a fresh, new technology business focused on transforming DSO and dental due diligence through a unique and exclusive partnership with dental AI market leader Pearl.

These new businesses were borne of my desire to continue to disruptively innovate dentistry and explore blue oceans of opportunity that squarely intersect with specific market needs.

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DSOPro: Explain what SmartDiligence.ai does and why you chose to focus on bringing it to the dental industry.

Eric Roman, Tyson Edwards, and I determined from our collective experience building DSOs, and also helping others build and manage their DSOs, that dentists typically perform inadequate due diligence. DSOs do not usually fare much better. For such an important, expensive investment decision we knew investors and practice buyers required more complete information to make the best decisions. There needed to be a better way to provide insightful analysis and better information to determine:

  • the key risks of an acquisition
  • the existing revenue upside opportunity
  • the patient population data
  • actual clinical disease rates
  • the specific levers and recommendations needed to optimize each acquisition post-transaction.

The analysis we now provide answers all these questions and more. The value to our clients is unmatched and truly an exponentially more useful approach to dental due diligence than the expensive, low-value, box-checking reports that some investors and DSO leaders pay way too much to obtain. Our vision is that every DSO investment and dental practice acquisition made will obtain a SmartDiligence analysis prior to closing to ensure buyers know exactly what they are purchasing. We know that smart buyers wouldn’t make a major purchase like a home without getting a home inspection, so why would anyone buy a dental practice without doing their SmartDiligence?



As we theorized the optimal due diligence information needed, we asked ourselves questions like these:

  • Am I getting a great deal or buying a nightmare?
  • How much ACTUAL disease and revenue potential associated with it exist in a practice?
  • What training is needed to optimize patient care and revenue growth?
  • How good are the existing clinicians at diagnosing and treating disease?
  • How easy would the existing clinicians be to replace?
  • How much specialty potential exists in this practice?
  • What are the risks hidden within the practice?
  • What would happen if you purchased a practice and simply elevated them up to the standards of your average practice? How much additional revenue will I gain if I accomplish this?
  • What percentage of patients are in-network, out of network, and cash?
  • Which contracted insurers are not worth keeping and why?
  • Is the practice patient base older or younger and which ones are not coming back?

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During the past 2 years and after extensive market research with investors and DSOs, we reverse engineered the SmartDiligence analysis to ensure the product answers all the questions you would want to know before you make a practice or DSO purchase. We also cover many questions nobody even thinks to ask but that are critically important. Our exclusive SmartPotential analysis provides high-value estimations of revenue gain from implementation of SmartDiligence-recommended operational improvements, something that every buyer should know. In short, we created the product we would need to make the best decisions and we believe all buyers need to have in order to ascertain the quality of a dental or DSO acquisition.


DSOPro: What are your thoughts about the future?

I will soon enter my third decade working in the DSO space and it is invigorating to be a part of a company like SmartDiligence.ai. We are creating win-win-win situations, supporting aspiring dentists and DSOs to make better decisions on acquisitions, and helping the industry evolve through disruptive innovation of outdated practices. I’ve never been more excited about the future or the blue oceans of opportunity that yet await us as dentistry continues to grow and evolve.



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About Jeromy R. Dixson, DMD, MBA


Dr. Dixson is a top DSO thought leader/influencer (Group Dentistry Now 2019) with nearly two decades of experience, a three-time Inc. Magazine 500/5000 awarded entrepreneur, Founder/CEO of Dental Capital Partners, Co-Founder of SmartDiligence, and the Founder/CEO of The DSO Project, dentistry’s first DSO accelerator. Dr. Dixson also provides Board Services to private equity firms and other investors. He is a trusted DSO/dental industry advisor for private equity firms, dental technology companies, and global dental brands in a variety of capacities. Dr. Dixson has created strategy and assisted the building of multiple $100+ million revenue dental groups with 9-digit valuations.


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