What is the de novo checklist for a DSO?
On this page
A single repeatable template that runs from site selection through lease, standard design, permits, construction, equipment, IT, regulatory filings, payer credentialing and launch, with one owner per step. DSO affiliation reached 16.1% of U.S. dentists in 2024, up from 7.2% in 2015 (ADA Health Policy Institute). In 2026, groups that standardize open faster.
Key facts
| Item | What the source says | Source |
|---|---|---|
| DSO affiliation | 7.2% of dentists in 2015 to 16.1% in 2024 | ADA HPI |
| Lease to CO | Typically five to nine months for a dental build-out, depending on jurisdiction | Curve Dental |
| Payer credentialing | Major carriers can take 90 to 180 days to process | Curve Dental |
| DEA | A separate registration is required for each place of professional practice where controlled substances are dispensed | 21 CFR 1301.12 |
| Amalgam separator | New sources file a One-Time Compliance Report within 90 days of first discharge to the POTW | 40 CFR 441.50 |
| X-ray assembly | Assembler reports go to the purchaser and state agency within 15 days | FDA |
| Operatory count | Plan operatories from a ten-year production plan | ADA |
Why does a DSO need one template?
Because most of every de novo repeats, and the misses tend to repeat too. A template captures the standard operatory, the standard equipment package, the standard network, and the sequence, so each new site starts from the last one instead of from scratch. It also lets the group compare sites: cost per operatory, days from lease to CO, days from CO to first patient.
The checklist
Phase 1: Site and lease
- Market study and site shortlist
- Test fit of the standard layout in the candidate space
- Utility check: water, sewer, power capacity, gas if needed, internet providers at the address
- LOI with TI allowance, landlord work, delivery date and remedies
- Lease review, including assignment and exclusivity
See the lease negotiation checklist and build-out delay liability.
Phase 2: Design
- Operatory count from the location's ten-year plan (ADA)
- Standard operatory template applied; see standard operatory templates
- Equipment package and utility templates to the architect
- IT drop map, rack location and camera plan in the drawings
- Mechanical room sized for compressor and vacuum
Phase 3: Permits and construction
- Permit drawings submitted; track every review comment
- GC contract with substantial completion, delay remedies and closeout list; see contract clauses
- Inspections scheduled and logged; see dental office permits
- Certificate of occupancy
Budget the schedule: lease to CO typically runs five to nine months for a dental build-out, depending on the permitting jurisdiction (Curve Dental).
Phase 4: Equipment
- Order long-lead equipment against the construction schedule
- Delivery and install sequence with the GC
- X-ray assembly reports filed within 15 days of assembly (FDA) and state registration (rules vary)
- Every item entered in the group inventory with serials and warranty dates
Phase 5: IT and security
- Standard firewall, switch, Wi-Fi and phone configuration
- Workstations imaged on a supported OS
- PMS and imaging connected to the group's systems
- Backups configured and a test restore done
- All admin credentials owned by the group, not the vendor
Phase 6: Regulatory and payers
- DEA registration for this location: each place of practice needs its own (21 CFR 1301.12)
- Amalgam separator installed; One-Time Compliance Report within 90 days of first discharge (40 CFR 441.50)
- State facility or dental board requirements
- Payer credentialing for each provider and location, started early; it can take 90 to 180 days (Curve Dental)
Phase 7: Launch
- Staff hiring and training on the group's standard workflows
- Mock patient day: every chair, sensor, printer and phone tested
- Pre-open marketing
- Punch list closed, final payment released, closeout documents filed
Who owns each phase?
| Phase | Typical owner |
|---|---|
| Site and lease | Real estate lead with counsel |
| Design | Design or construction lead with architect |
| Permits and construction | Construction lead and GC |
| Equipment | Procurement lead and dealer |
| IT and security | IT lead or MSP |
| Regulatory and payers | Compliance and credentialing team |
| Launch | Regional operations |
One person should own the master schedule across all seven. See one source of truth for the build-out team.
What do de novos most often miss?
- Internet service ordered late. Business circuits can take weeks to install; order at lease signing.
- Credentialing started after construction. It runs in parallel, not after.
- Device locations changed after permit drawings. Lock the IT and equipment plan before submittal.
- Vendor-held logins. The firewall, phones or cameras end up registered to an installer.
- No as-built inventory. The site opens without a record of what was installed where.
What should the group measure?
Days from LOI to lease, lease to permit, permit to CO, CO to first patient; cost per operatory against budget; and change orders per site. Compare each new site with the template, then fix the template. For cost benchmarks, see dental operatory cost and the build-out timeline.
Which free tools help with this?
The build-out cost & timeline calculator (free tool, coming soon) is planned to estimate build-out cost and timeline from square footage and operatory count. The dream-practice builder (free tool, coming soon) is planned to let you lay out rooms and operatories before anything is drawn. The permit & inspection tracker (free tool, coming soon) is planned to track permits, inspections and the certificate of occupancy in one place. The network & IT plan generator (free tool, coming soon) is planned to turn a floor plan into a network, drop and rack plan. The credential ownership checklist (free tool, coming soon) is planned to list every login, license and account the practice should own, with a "password hostage" letter template. The equipment inventory & appraisal report (free tool, coming soon) is planned to turn your equipment list into an appraisal-ready report. FloorStack Studio (live, free plan) places every device on your floor plan and gives you a device schedule with rooms, ports and cable lengths (FloorStack FAQ).
How FloorStack helps
FloorStack is a dental build-out platform built for repeatable openings. Full Stack ($119 per location per month, billed yearly) is for groups with 2+ locations and adds a group dashboard, standard builds across offices, and SSO, roles and API (FloorStack). Studio (live, free to start) maps every device on each site's floor plan with a device schedule, drop map, rack layout and bill of materials with a budget range. The free tools (all coming soon) cover each phase: the Build-out cost & timeline calculator for budget and schedule, the Dream practice builder for layout, the Permit & inspection tracker for permits and CO, the IT & network plan generator for the network, the Credential ownership checklist for logins, and the Equipment inventory & appraisal prep tool for the asset record. See the Build a Dental Office hub.
Free tools for this step
- Build-out cost & timeline calculator: per-site budget and schedule (free tool, coming soon).
- Dream practice builder: apply the standard layout (free tool, coming soon).
- Permit & inspection tracker: permits, inspections, CO (free tool, coming soon).
- IT & network plan generator: the standard network per site (free tool, coming soon).
- Credential ownership checklist: logins owned by the group (free tool, coming soon).
- Equipment inventory & appraisal prep tool: the asset record from day one (free tool, coming soon).
- Studio: every device on every site's floor plan (live).
Frequently asked questions
How long does a DSO de novo take?
Lease to CO often runs five to nine months, plus launch time (Curve Dental).
Does each location need its own DEA registration?
Yes, for each place of practice where controlled substances are dispensed (21 CFR 1301.12).
When should credentialing start?
As early as possible; carriers can take 90 to 180 days (Curve Dental).
What's the amalgam separator deadline?
A One-Time Compliance Report within 90 days of first discharge for a new source (40 CFR 441.50).
Should every location use the same operatory?
As close as the space allows; see standard operatory templates.
How do we track equipment across locations?
One inventory with location as a field; see multi-location equipment inventory.
Sources
- FloorStack: Frequently asked questions
- ADA Health Policy Institute: U.S. Dentist Workforce 2025 (PDF)
- ADA: Determining Ideal Size and Space
- Curve Dental: How to Start a Dental Practice, Launch Sequence
- 21 CFR 1301.12 (Cornell LII)
- 40 CFR 441.50 (Cornell LII)
- FDA: Diagnostic X-Ray Reports of Assembly
- FloorStack home page
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