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How to Choose Real Estate for A Dental Practice Startup

If you’re a dental associate thinking about a dental practice startup, you’ve probably dreamed about what your building will look like and where it will be. Before making any decisions, learn the pitfalls and traps that can cause you to make irreparable decisions.

Here, I will tell you about the three main things you must understand so you can be prepared and avoid the costly mistakes other associates make.

By the end of this article, you will learn:

  1. Location Planning – How to structure your strategy
  2. Avoid the Myth of the Corner Property
  3. The importance of Demographics Ratio for a dental startup

We will also help you understand the answers to some of the most common questions dental associates have when considering a dental startup:

  • Should I rent or buy real estate?
  • How much can I afford?
  • How do I choose the right location?
  • What size is best for a startup?
  • Are strip malls better than stand-alone buildings?
  • Which signs are best for dentists?

Finding the right answers to these questions is important because real estate is the highest cost in your startup budget.

Avoid the Biggest Real Estate Mistake in Startup Dental Practices

The #1 piece of cautionary advice during your research stage might surprise you.

If you avoid this mistake, you will save yourself hundreds of thousands of dollars.

My name is Jayme Amos, CEO of Ideal Practices. Our team of expert consultants has helped hundreds of doctors open successful startups all over the country. Along the way, we have learned a lot about things that work.

We have also learned about things that don’t work, mostly through the mistakes of others. Trust me—I get many emails from frantic doctors who need assistance and guidance after making poor choices. I want to share with you how to avoid the most dangerous—and expensive—mistake in the startup process.

Without question, the biggest mistake is this: “hopping in the car” to look at dental real estate during your research stage.

Don’t believe me?

I will show you how avoiding this mistake can save you more than 50 percent on real estate costs with your startup.

It’s a common mistake. When considering dental real estate for their startup, dentists “hop in the car” to drive around and look at buildings and locations. It feels exciting to see real estate and imagine the possibilities for your practice.

When they find realtor signs in the windows of properties that look good, such as a corner lot or one with high visibility, they make the call. They leave messages for several realtors.

Sounds like a typical step in the process, right?


Doctors who do this have just stepped into a trap.

Protect Your 3 Strongest Real Estate Strategies

The doctor who stepped into that trap just gave up the 3 most valuable and powerful negotiation pieces.

Sadly, those doctors believe they’re doing the right thing. What they don’t realize is that they just gave up control and lost money. Lots of money.

Keep reading to learn how we have helped hundreds of associate dentists prevent dangerous, expensive mistakes. They followed our process and went on to open highly successful dental practices.

Here we go…

The Startup Denstist

TOPIC #1: Location Planning for Dental Startups

I’ve helped negotiate over $100 million in dental real estate transactions for myself and our clients.  The concepts I share with dentists are often surprising. But consider the proof. The concepts I will share have helped build hundreds of successful startup practices all around the country.


Who hasn’t heard the above statement? Everyone from realtors, so-called “experts,” and even infomercials, chant it. Your priority? “Location! Location! Location!

They say things like:

  • Open at a busy corner
  • Look for busy traffic patterns
  • Seek out road frontage
  • Find the walk-by traffic

Wrong. It’s just not true for successful dental startups.

How Do I Know?

Here’s an example from one of my High-Level Consulting Clients, Dr. Alexis. She’s located just outside a city on the east coast.

We helped her negotiate, buy, and open her practice in a building she now loves. It’s located on the backside of a building on a slow road. She now owns the building, and her new dental office is exploding with growth.

Take a look at Dr. Alexis’ building here:

Her result?

Dr. Alexis attracts over 100 new patients per month…in her startup…without pricey dental office real estate.

Funny enough, shortly after her first anniversary, she told the marketing agency to pause her marketing campaign because she had too many patients (1500+ in just 14 months).

You may wonder how that is possible without following the location-location-location hype.

Remember, she’s on the backside of that building on a side road just outside of town.

Visibility not included.

This didn’t stop her from a million-dollar production in her first year. A million dollars. If that’s what you want to do, then you’ll need to follow a proven plan for success.

Don’t follow the hype. Don’t listen to the peanut gallery. Do what is proven over and over.

How did Dr. Alexis do it? That’s why we’re here. We can show you.

Watch Dr. Alexis’ story here.

What About Locations in Other Markets?

Dr. Mark Costes and I recorded an episode about nationwide private-practice startups earlier this year. In this podcast, we covered some of the biggest myths in startups, including “hopping in the car” and the doctor-to-population ratio.

In this podcast, you will hear us discuss three doctors who followed our entire proven process:

  • Bryan – near Nashville – just opened his dental practice startup with 84 patients on his 2nd day
  • Danny – just finished 12 months in his startup with $1 million in collections (he had zero business experience prior to opening)

Dr. Gerry – in an east coast metro area – had 300 patients in his first 6 weeks and a million of production in the first 12 months

2 Mistakes from “That” Doctor Who Hopped in The Car

Mistake # 1: Location Planning

Your dental real estate choice will lock you in for 5-10 years with a practice that will determine the rest of your career.
Your career and future deserve better than a casual Sunday drive in the car. This decision could easily cost you half a million dollars and should be treated as a formal business decision. Not like shopping for a new outfit.

Instead of location-location-location, start with the 7 Steps for Real Estate Planning:

Step 1: Build a legitimate dental startup business plan

Step 2: Create a financial roadmap to guide you through the first 12-24 months, based on data from hundreds of startup practices

Step 3: Plan the intangible aspects of your Startup Practice Vision. These will direct your real estate options, keeping control in your hands. The Vision topics will help you enjoy practice ownership at the highest level with a pre-planned growth strategy, patient experience, and profitability goals

Step 4: Confirm you’re free of legal restrictions. Often, this is related to the subtle legal points in your associateship agreement. Don’t be like doctors who accidentally get into expensive legal problems with their associateship employer

Step 5: Study the population and region. Ensure the specific region you desire has an abundance of your ideal patient population, aligned with enough opportunity for the level of profitability that you want for your startup

Step 6: Secure well-negotiated financing.

Step 7: Hire a non-realtor advisor (attorney or consultant) to guide your dental real estate research process. Someone who does not have the bias of a commission. Remember the bias of commissioned salespeople. Realtors get paid when you sign for real estate, even if it’s not the right real estate for you.


Only after all 7 steps should you look at dental office real estate. Never sooner.

What happens if you skip one of these 7 steps?

Mistake # 2: Skipping Crucial Steps

Here are two recent examples of doctors who did this the wrong way:



Dr. A signed for a piece of real estate. He was a month into construction on his office when he realized he made a serious mistake. He emailed me in a panic. The town mailed him a certified letter, formally instructing him to stop construction. The law stated that dental offices were not permitted to build in that location.

It was officially illegal to have a dental practice there!

Could he fix his problem? Yes, with tens of thousands of dollars in legal bills or rezoning regulations with his town. But this easily could have been avoided if he followed steps 1-7 before “hopping in the car.”



Dr. T attended our course, the Startup Practice Blueprint. This two-day course is cram-packed with helpful information that is explained by the top experts in startup dental practices. Many associate dentists have attended this course and gone on to build successful dental startups.

Dr. T wanted to be one of those doctors. He was so excited by all he learned, and he was ready to do it alone. Sadly, he didn’t admit that he had already signed the dental lease agreement. Six months later, I saw him post in a social media group that he wasted another eight months trying to negotiate with the landlord for more parking. What negotiation could possibly take that long?

Due to the size of his building and the local law, his location required him to have 12 parking spots, but his lease only allowed for 6.

The landlord wouldn’t negotiate. It turns out he was saving those additional parking spots for his own company that was moving into the same building. The doctor was trapped, having invested eight months without any progress. He ended up having to start his dental real estate process all over again.

Talk about a waste of time and money!


Here’s the reality:
“You will have few choices in life that affect your future more than the real estate and location of your dental practice.”

Do this the right way. Plan your startup like the crucial business decision it is. Don’t just hop in the car.

**Real estate is simply a byproduct of all your planning. **

Do not start with real estate. Instead, follow the wise and predictable path that allows the process to give you the real estate solutions.

The 13 Stages Process for Dental Practice Startups

The 13 Stages is our proven sequence for dental startups. It has worked hundreds of times all over the country, creating some of the most impressive startups in recent years.

When you follow the 13 Stages in order, taking the right amount of time to thoroughly complete each step, you’ll be able to find and secure real estate that supports your vision.


Access a Free 13 Stages Study Guide and Timeline Here:

TOPIC #2: Avoid the Myth of the Corner Property

Corner properties.

This one topic alone has created more problems for dental startups than any other real estate topic. Corner properties are like a great myth in startup dentistry.

Have you ever heard of the Siren’s call?
It comes from the tale of a beautiful Greek mythological mermaid creature who sat on the rocks near the shore and called out with her song to the passing sailors.

Her enticing voice enthralled the sailors and lured them in. As each sailor heard her seductive call, they drew closer. When they saw her, they became so magnetized by her beauty that they crashed into the shore. As their boats sank, the sailors swam to the Siren to be saved.

But the Siren had this all planned in advance. She enticed them. Lured them in. The sailors had no idea of the danger they were in. They were mesmerized. And when each sailor finally reached her, he embraced her.

But instead of a kiss, she pulled the exhausted sailor underwater and drowned him.


Corner real estate is like the Siren’s call.

The Danger of Corner Real Estate for Dental Startups

Many doctors are lured in by the bragging rights of the corner property. They are told that the visibility will be the key to practice growth.

But I can give you dozens of case studies of my consulting clients who have no visibility and nearly no signage. Many of these doctors have incredibly profitable practices just weeks or months after opening their doors. But better than the profits, these doctors are proud of their dental practices. And they do it without the expensive corner real estate.

People who have never opened dental office startups tell these doctors they need corner real estate. The facade of prestige makes those doctors sink.

But startups don’t need corner real estate. This surprises people who haven’t opened startups before. Dental startups do not need corner real estate.

Why is this important? Because you can save 50% on your real estate costs and still have a thriving startup practice. 


When is Corner Real Estate Needed?

Listen, if you’re opening a McDonalds or a Starbucks, you need corner real estate.
Those businesses need impulse buyers because their business model requires it. Without a drive-through, their business would likely fail.

But have you ever seen a drive-thru-prophy?
Of course not!

How many patients do you think see a highly visible dental office while driving somewhere and impulsively decide to exit the freeway to run in for a quick crown?

The business model of your practice does not require corner real estate. Your practice won’t rely on impulsive buying or need a drive-through.

So, if you can save 50 percent on dental real estate by ignoring the corner property, why would a realtor want to entice you into choosing it?

Because realtors get paid on commission. The more she convinces you to spend, the more she makes. If you save 50 percent, that means she loses 50 percent of the commission she is hoping for. Think that may affect her motivation? Her advice?

Even the most honest realtors are paid only on commission, and their advice is affected by their ability to put food on the table.

It is crucial to see this bias with all vendors, but realtors in particular. You are going to spend a lot on dental office real estate, and they want as much of the pie as they can get. 

Unless a vendor has helped open at least a hundred dental practice startups, ignore their biased advice.

The Danger on the Sign

Let’s go back to the doctors who “hop in the car” and call the number on the sign.

Pay close attention to this detail. This one mistake strips dentists of their control in the negotiations.

Guess who the phone number on the sign belongs to? The landlord’s realtor.
Whose realtor?
That’s right, the landlord’s, not yours.


In a dental real estate transaction, you need your OWN representative.

It’s an incredibly poor negotiation strategy to begin real estate discussions representing yourself.

But that is what those doctors do when they “hop in the car” and start making calls.

Your negotiating strength drops instantly.

I see this all the time. And it breaks my heart when I see how much money dentists lose when they start calling signs on real estate.

Negotiating your own real estate is a little like putting a golf ball into the hole. If you’re 20 yards away, a miscalculation of 2 degrees makes you miss the hole.

Just 2 degrees is the difference between success and failure.

It’s like that in dental real estate negotiations. Being off by even a few “degrees” could cost you hundreds of thousands more than you should pay. Wasting years of profits.

Even worse, in real estate, you can jeopardize the long-term legal protection for your practice. I hear countless stories of doctors who get kicked out of their dental office real estate—with just weeks of notice—setting them back in incalculable amounts financially.

Imagine what that would do to your savings.

Think of the stress when you realize you signed a legal document that hurts your family’s future. Especially when you know it could have been avoided if you didn’t try to negotiate for something so expensive without having any real experience.

It’s not your fault, really. You just haven’t done this before.


But this is what happens when you start by “hopping in the car.” You’re going to be off by at least a few “degrees” because this is your first time entering this process.

Here’s the humble pill:
Real estate is a big game represented by big lawyers, big players, and big money.

Where are you best? Chairside!

But that doesn’t make you effective in your first commercial real estate transaction. This is the “big leagues” of negotiation. This lease could be worth a few million dollars throughout your career.

Buzzwords Like “Tenant Improvement Allowance”

What about buzzwords like Tenant Improvement Allowance (TIA)?

Those doctors who call the number on the sign try their best to sound educated. Unfortunately, the Landlord’s realtor instantly spots an easy target on the phone.


On that phone call, it is important to remember these 6 perspectives from the landlord’s realtor:

  1. The Realtor’s Loyalty is to the landlord (not you).
  2. The Realtor’s Job is to make the landlord the most money (not you).
  3. Landlords laugh when tenants say: “He needs me, that space has been empty for a long time.” (Rarely does a commercial landlord “need you.”)
  4. The Realtor’s Income comes from the landlord (which shows you who is in charge).
  5. Those doctors on the phone make it obvious that they are an easy “mark.”
  6. Some doctors like pretending they’re deal-makers, so they use fancy terms like “TIA,” “CAD/CAM,” and price per square foot. But this shows more weakness than strength in negotiations.

Those Dentists think using buzzwords will show the realtor intelligence.

In reality, using buzzwords reveals a financial opportunity for the landlord, not you.


Patients who Try to Teach You about Implants From their WebMD Education

Some patients quote online information that has no relevance to their clinical needs. It’s embarrassing for them, isn’t it?!  They’re trying so hard. And they’re smart people. But they are trying to convince you about a different treatment plan based on WebMD.

I bet you can spot their “WebMD educations” a mile away, can’t you?


It’s like that with realtors. Realtors can spot “that dentist” a mile away.

The world of real estate is THEIR operatory. They’re in that space every day, building an entire career protecting the landlord. Not you.

That’s why even landlords with tens of millions of dollars of real estate HIRE realtors: to represent THEM, not you.  Worse, realtors receive financial rewards when you pay higher rent.

This is the core problem with calling the number on the sign.

Let’s avoid you becoming “that doctor.”

Then we can focus on more important things like demographics topics.

TOPIC #3: The Importance of Demographics Ratios for a Dental Startup

Many doctors are told to chase the “ratio” as a primary factor for their dental practice startup. I want to share with you why this is a bad idea.

But first, let’s talk about which ratios are healthy. I write about this in detail in my bestselling book Choosing the Right Location. Get your free copy and learn everything you need to know about how to choose the best location for you.


The Population to Doctor Ratio

I was the first person in dentistry to publicly publish the ratio in a book, stating it should be at least 2000:1. This represents a concentration of 2000 people in a geographical area for every 1 dentist. 

In theory, higher is better, implying easier growth.

In other words, 2000:1 reveals that you found a smart location.

But the information is not complete.

Over the years, we’ve built strategies that make the ratio irrelevant.


It will shock most dentists to hear me officially state:

“The Population to Doctor Ratio Can be Made Irrelevant”

For example, consider Dr. Bryan, who had a million-dollar practice even with “bad” demographics. Dr. Bryan’s ratio was only 1504:1.
That’s not good. It’s nearly 25 percent LOWER than my book’s suggestion. Most of the so-called “experts” on social media will tell you to stay away from that location.

Yet, on DAY 2, Dr. Bryan already had 84 patients.

Even with a bad “ratio.”

In his first year, he collected a million dollars.
Shocking, right?

So why did we recommend that area?  My team of consultants knew this was the right area for Dr. Bryan because we built the strategy for his entire dental startup business plan based on his vision. Not a ratio.

See, a mathematical ratio never made a dental office successful. Even more important, when did you ever meet a retiring dentist who said he was proud of his career…because of his ratio? I’m betting never.

A “Bad” Demographics Ratio with Amazing Results

See, a ratio is just a cookie-cutter math equation.

Those so-called “experts” will tell you to avoid “low” ratios.

They will say something like, “The numbers are bad. The spreadsheets show warning signs.”

But you can ignore their cookie-cutter advice meant for the masses. You want a customized plan that addresses YOU. Your LIFE. Your VISION. Based on your custom dental startup model. Considering the kinds of patients you enjoy serving most and the impact you want to make in your community.

Ratios are based on a math equation that doesn’t take your vision into consideration. And “experts” try to use the ratio numbers to make you believe it’s a good area. But if it were that simple, why do so many dental office startups struggle?

…and how do doctors like Dr. Bryan do it with “bad” demographics? Advice for the masses is not customized advice for YOUR LIFE. 

What about Online Demographics Reports?

I’m sure you know colleagues who bought online dental demographics reports and followed the “expert” advice who struggle in their startup.

They followed “the ratio,” but they’re not making a profit. Where are those demographics “experts” then? 

Here’s the gut-wrenching truth: the “ratio” does not bring success to a dental startup.

Read that again.


When I speak on stage, my recommendation to all associate dentists is to avoid chasing the “ratio” as a primary factor for your startup.

Another example…
Dr. Gerry (again, from above) had a great ratio of 3000:1. In his first month and a half, Gerry already had 300 patients.

But 85 percent of my startup clients should NEVER consider Dr. Gerry’s city.

The ratio is a FALSE POSITIVE for most dentists.

The False Positive in Dental Demographics

Here’s the reason why you don’t want to open a practice in Dr. Gerry’s town: A high percentage of those patients are Medicaid recipients.
For Dr. Gerry, it’s perfect. He LOVES serving that population. He loves the pace. That rhythm. That practice model.  It’s perfect for HIM. It’s perfect for his entire startup plan.
But is it right for you?

How awful would it be if you opened a dental practice startup in that location because “the ratio” looked good?

You might have patients, but would you be happy?
Would it be the kind of practice that’s right for you?

Or would it just fit the math equation that some online report guy sold you?

See, this isn’t about following cookie-cutter advice.
Finding the perfect location for you isn’t about buying a report from a so-called expert so you can stare at piles of data.  This decision isn’t about calculations.

This is about your life.
Your dental practice startup will define your life, your career, and the reputation you create for your family.
Not data. You are not a calculator. You are not a spreadsheet.
You’re a dentist.

Got it?

Remember Dr. Bryan?
If he followed the cookie-cutter online advice about ratios, he would have missed the richness of his 1504:1 dream. This is why he’s in a location that he and his wife are over-the-top proud to be in.

You can watch Dr. Bryan’s entire story in the Startup Practice Documentary at

Click the Play Button to Watch the Documentary

Watch and see why Dr. Bryan owns one of the fastest-growing startups in America. He told me he can’t stop smiling. He said it’s better than he ever imagined it would be.

But he would have missed out on 84 patients in the first 2 days if he did what people online say to do.

And like Dr. Gerry, if YOU opened in his city, you might be frustrated for decades, stuck with a false positive. A patient population you don’t love serving.  Because of trying to follow the ratio advice for the masses.

The Real Estate Solution for Startups

Remember all the question I said I would help you answer?

  • Should I rent or buy real estate?
  • How much can I afford?
  • How do I choose the right location?
  • What size is best for a startup?
  • Are strip malls better than stand-alone buildings?
  • Which signs are best for dentists?

Here’s the secret to answering all of them: It all DEPENDS ON YOUR VISION.

You can’t know the answers to any of those questions until you first know your vision. What type of practice do you want to own? Do you want a boutique practice? Are you a pediatric dentist? Are you wanting to care for families or high-end professionals? Or would you prefer serving the underprivileged? What type of patient experience do you want to provide? What do you want your future to look like?

You want a custom plan—not a plan built on advice from people’s online opinions who have never opened more than one practice. If any at all

Don’t “hop in the car” and damage your whole career. Let’s treat this like the real business decision it is—and get it right the first time.

Beware of the Siren’s call of corner properties. You don’t need a corner property to succeed, even if the so-called “experts” try to sound smart by telling you to spend 50 percent more on real estate costs. Look at the hundreds of successful dental startups that prove it is the plan, not a corner, that makes them profitable. 

You deserve better than risking your future based on the seductive dangers of a Siren singing to you from shore.

Startups—when done the right way—can be the best part of your career and future.
They can be profitable in the first weeks.
They can match your clinical philosophy on day ONE.
They can represent you authentically, making your community and family proud of your accomplishment.
It’s worth getting right.

Invest the time and energy to get it right the first time so you can step confidently into dental practice ownership. 


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At Ideal Practices, my consulting team and I have assisted hundreds of doctors over more than a decade to get their practices up and running. Let’s get your startup right.

When you partner with us, the first thing we do is figure out your vision. We do this through an in-depth Vision Call. Once we understand your vision, we REVERSE ENGINEER your dental startup business plan based on your vision. This plan answers the above questions.

Interested in your customized Vision Call? Apply today to become one of our high-level consulting clients.

If you aren’t ready for that, come meet me and my top consultants at the next Startup Practice Blueprint Course.

This course teaches you the 13 Stages Process and gives you one-on-one access to the top experts in startups from around the country.

Go to to request an invitation to the course.

Click here to Request an Invitation to the Course

Courses fill up months in advance because we accept only 24 attendees per course to give everyone personal time with the experts, so don’t delay!

Will you be one of this year’s success stories? I hope to meet you personally!


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Choosing The Right
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