What a De-Novo Dental Practice Actually Costs
A de-novo dental practice is a $400K–$900K project depending on operatory count, finish level, equipment tier, and market. This is the real budget — itemized.
Buildout
Per-square-foot dental buildout runs $150–$300 depending on market, finish level, and code requirements. A 1,800 sq ft 4-op office in a Class B suburban market: $300K at $165/sf. Same office in San Francisco or NYC: $450K+. Plumbing, vacuum/compressor lines, and lead-shielded x-ray rooms drive most of the variance.
Equipment
Four operatories fully outfitted: $35K–$50K per op × 4 = $140K–$200K. Add CBCT ($80K), pan/ceph (often replaced by CBCT or skip), intraoral scanner ($25K), sterilization center ($15K), business equipment ($10K). All-in equipment for a typical 4-op de-novo: $250K–$330K.
Soft costs
Architect + engineering: $15K–$30K. Permits: $5K–$15K. Legal (lease review, entity setup): $5K–$10K. Practice management software setup: $5K–$15K. Marketing pre-open: $10K–$25K. Total: $40K–$95K.
Working capital through ramp
Months 1–6 are net cash-negative for most de-novos. Plan $50K–$150K of working capital reserve to cover payroll, lease, supplies, and debt service through ramp. Specialty lenders typically include this in the project loan as a separate working-capital sub-loan or interest-only ramp period.
Total ranges
Lean 4-op suburban de-novo: $400K–$550K all-in.
Standard 4-op de-novo: $600K–$750K all-in.
Premium / large 6-op de-novo or major metro: $800K–$1.2M all-in.