Executive operations leadership for groups that outgrew their systems.

49 North Dental Advisors serves dental groups with 1–25 locations — the ones where the owner is still the operational bottleneck, the P&L varies wildly by office, and nobody owns the numbers. Twenty years of multi-state DSO operations, one to two days a week, at a fraction of a full-time executive.

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The wall at 1–25 locations

Growth exposed the gap between owning practices and operating a group.

Every growing group hits it. The systems that worked at two offices quietly fail at five. The owner absorbs the difference personally — more hours, more firefighting, less margin — until something forces the question.

A full-time COO costs $250–350K. Most groups don't need one full-time. They need one who's done it — a day or two a week.

01 The owner is the bottleneck for every operational decision — and can't take three weeks off without the wheels wobbling.

02 Every office reports differently, or not at all. Nobody can say which location is underperforming, or why.

03 The last acquisition never fully integrated — different systems, fee schedules, and cultures under one logo.

04 Hygiene reappointment, case acceptance, and schedule utilization leak revenue that never shows up on a report.

05 EBITDA trails benchmarks by 5–15 points — which compounds directly into valuation when a sale or recap comes.

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