Back in June, the Colorado Dental Board amended Rule 1.7 (3 CCR 709-1) to address dental practice ownership. Importantly, these amendments explicitly address dental service organizations (“DSOs”). The changes take effect January 1, 2027, so licensees (i.e., dentists) and DSOs should review their arrangements ahead of the effective date.

Who Can Own a Dental Practice? Only a Colorado-licensed dentist can be the “proprietor” of a dental practice, with limited exceptions for qualifying nonprofits, political subdivisions, and provider networks. C.R.S. § 12-220-303. Dental hygiene practices may also be owned by licensed hygienists.

A “proprietor” includes any person who:

1. employs dentists, dental therapists, dental hygienists, or dental assistants to operate a dental office (subject to exceptions in C.R.S. §§ 12-220-305 and 12-220-501);
2. provides dental material or equipment needed to manage a dental office to a dentist, dental therapist, dental hygienist, dental assistant, or other agent under a lease or other agreement for compensation; or
3. owns or controls dental equipment, material, or a dental office and makes it available for use by dentists or other personnel (with exceptions). C.R.S. § 12-220-104(13).

DSOs Cannot Be Proprietors. Rule 1.7 defines a DSO as “a business that provides business management services, including administrative, operational, and non-clinical support to dental practices,” and now makes clear the status of DSOs: “a [DSO] does not meet one of the enumerated exceptions under 12-220-303, and 304, C.R.S. and therefore may not serve as the proprietor of a dental or dental hygiene practice.” 3 CCR 709-1 Rule 1.7.E (emphasis added). Licensees practicing where a DSO acts as a proprietor may face discipline, though the Board will consider what the licensee knew and any efforts to come into compliance.

DSOs Can Still Have a Role. A licensee may still utilize the business management services of a DSO, as long as:

1. the DSO does not exert any influence over the licensee’s professional judgment and clinical decisions including diagnosis, treatment planning and documentation;
2. the licensee may delegate to a DSO responsibility for practice financial management, including the administration of patient accounts provided that: (a) the DSO does not interfere with professional judgment; (b) the licensee reviews all procedures billed for accuracy; and (c) the licensee retains the ability to alter a patient account should an error be discovered;
3. the licensee has immediate access to all patient records for treated patients; and
4. the payment agreement for services of the DSO is not improper fee-sharing as provided in C.R.S. § 12-220-201(1)(v). 3 CCR 709-1 Rule 1.7.E.2.

Also, amended Rule 1.7 clarifies that landlords are not proprietors if they only provide space, not dental equipment or materials. 3 CCR 709-1 Rule 1.7.F.

Takeaways. 

• Review ownership. Confirm that practice owners are permitted owners or meet a statutory exception.
• Audit DSO agreements. Review for DSO control over clinical decisions, billing, or records, and for improper fee-sharing.
• Forms. Update the required Practice Ownership Form postings. See C.R.S. § 12-220-303; 3 CCR 709-1 1.7.B.