1. National Dental Lease Rates
Median asking rents for dental space in the top 50 US metros, NNN, per square foot per year.
Rent growth is decelerating off the 2024-2025 peak, but is still outpacing dental collections growth (~3.1% YoY) — a margin compression story that hasn't reversed.
2. Hot vs Cold Markets — Top 10 Metros by Dental Rent Growth (YoY)
| Rank | Metro | Median $/SF/Yr | YoY Growth | Status |
|---|
| 1 | Austin, TX | $42.10 | +11.8% | Hot — overheated |
| 2 | Nashville, TN | $38.40 | +10.2% | Hot |
| 3 | Phoenix, AZ | $36.80 | +9.4% | Hot |
| 4 | Tampa, FL | $35.90 | +9.0% | Hot |
| 5 | Charlotte, NC | $33.50 | +8.1% | Warm |
| 6 | Boise, ID | $31.20 | +7.6% | Warm |
| 7 | Salt Lake City, UT | $32.40 | +6.9% | Warm |
| 8 | Raleigh-Durham, NC | $34.10 | +6.4% | Warm |
| 9 | Las Vegas, NV | $33.20 | +5.8% | Warm |
| 10 | Jacksonville, FL | $30.40 | +5.2% | Cooling |
Coldest Markets (Slowest Growth)
| Metro | Median $/SF/Yr | YoY Growth | Note |
|---|
| San Francisco, CA | $58.20 | -2.1% | Office collapse spillover into MOB |
| Chicago, IL | $31.40 | +0.6% | Population outflow continues |
| Portland, OR | $33.80 | +0.9% | Demand weakness post-2024 |
| Cleveland, OH | $24.60 | +1.1% | Negotiation opportunity |
| Detroit, MI | $23.40 | +1.4% | Negotiation opportunity |
3. DSO Acquisition Activity
2025 Deal Count
~890
est. dental practice acquisitions
2026 YTD (Q2)
~410
on pace for ~820
Median Multiple
7.2x
down from 8.1x in 2024
PE-backed DSO consolidation has slowed from its 2022-2024 peak. Higher rates compressed multiples; sellers who anchored to 2023 valuations are stuck. Best-in-class practices (>25% EBITDA margin, >$1.5M collections, multi-doc) still command 9-11x; everything else is in 5-7x territory.
4. Payer Mix Shifts
- PPO share declining — from ~58% of US dental visits in 2022 to ~53% in 2026 as practices drop low-reimbursement plans.
- Cash / fee-for-service rising — up to ~22% of practice mix, fueled by membership plan growth (~14% YoY) and HSA adoption.
- Medicaid expansion in 12 states in 2024-2026 — Pedo and OS practices are biggest beneficiaries.
- Delta networks tightening — fee schedule reductions in CA, TX, FL averaged -3.4% in 2026, pushing more GPs to drop.
- Aetna/Cigna employer consolidation reducing PPO leverage further.
5. Practice Sale Velocity by State (Median Days on Market)
| State | Median DOM | Listing Inventory | Trend |
|---|
| TX | 42 days | High | Fast |
| FL | 48 days | High | Fast |
| AZ | 54 days | Medium | Fast |
| CA | 78 days | High | Moderate |
| CO | 82 days | Medium | Moderate |
| WA | 96 days | Medium | Moderate |
| OR | 118 days | Low | Slow |
| IL | 134 days | Medium | Slow |
| NY | 142 days | Medium | Slow |
| OH | 156 days | High | Slow |
6. Distressed Property Opportunities
States with elevated distressed MOB / dental property inventory (foreclosure-adjacent, motivated-seller, or DSO-divested):
- California — Bay Area office spillover; ~120 distressed MOB assets tracked
- Illinois — Chicagoland; ~80 assets, weak refinance market
- Texas — overbuilt suburbs (Frisco/Cypress); ~95 assets
- Florida — insurance crisis cooling exit market; ~70 assets
- Pennsylvania — Pittsburgh / Philly secondary submarkets; ~55 assets
Distressed inventory creates entry opportunities for cash buyers and 1031 reinvestors at 12-18% discounts to 2024 highs.
7. 5-Year Forecast (2026-2031)
- Lease rates: 3-5% annual growth in hot markets, 1-2% nationally as rate environment stabilizes
- DSO consolidation: rebound to ~1,000+ deals/yr by 2028 as PE dry powder deploys; multi-specialty platforms favored over GP-only roll-ups
- Cash/membership share: projected to reach 28-30% of US dental spend by 2030
- MOB cap rates: compress 25-50bps as institutional demand returns; 6.5%-7.5% becomes the new normal
- AI integration in practice operations will tier valuations — adopters command 0.5-1.0x premium multiples
- Sale-leaseback volume will increase as boomer doctor-owners hit retirement and want capital out without exiting clinical work
8. Methodology
Dental real estate rent data triangulated from public CoStar/JLL MOB releases, broker network surveys, and our internal dataset of dental lease comparables aggregated from negotiated lease analyses across the platform. DSO M&A counts estimated from public announcements, regulatory filings, and PitchBook coverage of healthcare deal flow. Payer mix shifts informed by ADA economic data and CMS public datasets. Practice sale velocity drawn from broker MLS-equivalent listing aggregators and our own marketplace tracking. Forecasts are educational projections, not investment advice. All figures rounded for presentation. Underlying data points carry +/- 8% margin of error at the metro level.