Frequently asked questions

Alithos Advisory is an independent, flat-fee budget planning practice for dental office projects: de novo startups, relocations, and ground-up builds. Dan Ellyson builds one verified project budget that your lender, contractor, and equipment rep all have to answer to. Alithos does not sell equipment, construction, real estate, or loans, and takes no commissions from anyone.

The Budget Plan is a flat fee of $7,500–$10,000. The exact fee is set in writing, based on your project's scope, before any work starts. It covers the space requirement analysis, a line-item equipment and imaging budget, build vs. lease vs. condo cost projections, Section 179 and tax modeling, production targets and cash-flow analysis, debt-service coverage analysis, and the lender-ready package your bank underwrites from.

The Feasibility Check is a $2,500 flat-fee first step that credits toward the Budget Plan. It is a go / no-go financial screen: a space and site fit assessment, a high-level equipment budget range, a debt-service coverage pre-check against the 1.25× coverage lenders commonly look for, and a straight answer on whether the project is ready.

Project Navigator starts at $20,000 and is quoted per project. It includes everything in the Budget Plan plus owner-side advisory through opening day: independent quote review across equipment dealers and contractors, floor plan and design review against your budget, lender negotiation support, and change-order review. Project Navigator availability depends on your project's state and is confirmed before engagement.

It depends on where your project is. Some states regulate construction-related services more tightly than others, so Dan confirms which Project Navigator services can be offered for your project's state before any engagement starts. The Feasibility Check and the Budget Plan are available for projects in all 50 states.

Yes. Alithos Advisory is based in California and serves dentists nationwide. The work is done virtually, by video call and shared documents, so your project's location does not change the process or the published fees.

No, in either direction, ever. Alithos is paid only by the client, as a flat fee. Referrals flow in because prepared clients are good business for everyone at the table, but not one dollar flows back. If anyone ever offers, you'll hear about it from Dan first, with the word "no" attached.

Dealer design is paid for by the equipment order that follows it. It can be good work, but nobody whose paycheck depends on a bigger order will tell you to build smaller. An independent Budget Plan sets your operatory count, square footage, and equipment budget from your own production math first, so the free design becomes a proposal measured against your plan rather than the plan itself. More in The "free" office design isn't free.

No. Alithos Advisory provides independent budget planning and owner-side advisory only. It is not a licensed contractor, architect, engineer, real estate broker, lender, law firm, CPA, or investment adviser. You keep your own attorney, CPA, and lender, and the Budget Plan gives all of them the same verified numbers to work from.

Before you sign anything: the letter of intent, the lease, the equipment order, or the loan application. The plan is worth the most when nothing is committed yet. Already signed a lease? A plan can still catch the next six figures of decisions.

Most Budget Plans are completed in 3–5 weeks from kickoff, depending on how quickly your production and financial data can be gathered.

Your goals for the practice and the project, and your numbers. Existing practices bring about six months of real production and collection data, plus your current lease status. Startups bring their financial picture and target market, and the plan models from the Alithos planning benchmarks. Anything already on the table, such as quotes, a letter of intent, a lease draft, or a floor plan, helps too. It all goes into the Trust & Verify questionnaire at kickoff.

No one can promise a loan approval, but the package is built to match what dental lenders underwrite: total project cost with line-item support, cash-flow analysis, and debt-service coverage against the 1.25× benchmark many lenders look for. Lenders prefer prepared borrowers. See what dental lenders actually approve.

The Project Fit Call is free, 30 minutes, by video, with no pitch and no obligation. Bring your timeline and your questions; Dan will tell you which step, if any, makes sense for your project. Book a Project Fit Call.

No. The cost estimator is planning math, not a quote: it uses Alithos planning assumptions, a 15-year amortization at 8.25%, and the 1.25× coverage lenders commonly look for. A Budget Plan runs the same model against your own production data and market.

The Alithos planning model puts a 4-operatory startup in leased space at standard finish at about $746,000 to $824,000 all-in, and a 5-operatory startup at $887,000 to $980,000, both including $85,000 of working capital. An ADA News expert column says opening a practice often takes $500,000 at minimum (ADA News, 2025). The line-by-line breakdown is in the dental practice startup costs guide.

A 2026 guide from a dental law firm puts leasehold build-outs at $150 to $350 per square foot and ground-up construction often at $400 or more (Dental & Medical Counsel, 2026). The Alithos estimator assumes $170 (standard) or $220 (premium) in leased space and $340 or $420 for ground-up, before land. Your market can run higher. See construction cost per square foot.

Start from production and provider schedules, not the floor plan. Once the operatory count is set, the Alithos estimator sizes the space at 500 square feet per operatory for 3 to 5 operatories, 450 for 6 to 7, and 425 for 8 or more. That makes 4 operatories about 2,000 square feet and 8 about 3,400. Read how much space you actually need, or try the operatory square footage calculator.

The Alithos estimator carries $85,000 of working capital by default. It covers payroll, rent and supplies while insurance collections lag production by weeks and the schedule fills. An ADA News lender column cites a cash reserve at closing often in the $50,000 to $75,000 range, in an acquisition context (ADA News, 2026). How to size your own reserve is in working capital for a dental startup.

The Alithos estimator assumes $42,000 per operatory at standard finish and $58,000 at premium, plus imaging: $60,000 for sensors and a pano, or $130,000 with CBCT. A 2026 dental-law guide says equipment for a standard build alone is often $100,000 to $200,000 (Dental & Medical Counsel, 2026). Item-by-item ranges are in the dental equipment cost guide, and the CBCT decision is in CBCT or not.

The lines that are not in anyone's quote: design and engineering fees, permits, non-clinical cabinetry, IT and furniture, signage, loan fees and working capital. The Alithos estimator adds cabinetry at 10% and soft costs at 12% of construction, plus $45,000 and $3,000 per operatory for IT and furniture. Always ask each bidder what is excluded. The full list is in the hidden costs of a dental build-out.

Many dental lenders look for a debt-service coverage ratio of at least 1.25, as a guideline rather than a strict minimum (ADA News, 2026). DSCR is cash flow available for debt divided by debt payments (Bankrate). If the model's $784,800 4-operatory project were financed in full, a 15-year loan at 8.25% costs about $7,614 a month, so 1.25× coverage means about $114,000 a year of cash flow available for debt. Test yours with the DSCR calculator.

Credit, liquidity, clinical and production history, and a full project budget they can underwrite. Payment history and amounts owed make up about 65% of a FICO Score (myFICO). SBA lenders generally need a startup equity injection of at least 10% of project cost (Starfield & Smith, 2025). Some dental lenders advertise up to 100% financing, subject to credit approval (Bank of America). More in what dental lenders actually approve.

The SBA 7(a) maximum is $5 million. Terms run up to 25 years for real estate and generally up to 10 years for equipment and working capital (SBA). For loans over $350,000 the variable-rate cap is prime plus 3.0%, about 10.0% with prime at 7.00% on October 30, 2026 (Federal Reserve). That is a ceiling, not a typical rate. Compare loan types in the financing guide.

Possibly, and your CPA decides. For tax years beginning in 2026, the federal Section 179 limit is $2,560,000, reduced dollar for dollar once qualifying purchases exceed $4,090,000 (IRS Rev. Proc. 2025-32). California allows only $25,000 and does not follow federal bonus depreciation (FTB, 2025). This is education, not tax advice. Try the Section 179 calculator, then confirm with your CPA.

Run all three before you tour anything. In the Alithos model, a 5-operatory office in leased space at standard finish plans at $887,000 to $980,000 all-in, while the same office built ground-up plans at $1,379,000 to $1,525,000 before land. A condo sits between: you own the suite but pay association dues. The right path is the one your production can carry. See build, lease, or condo.

A TI allowance is landlord money toward your build-out, usually stated per square foot and often recovered through rent. Published ranges run from roughly $40 to $100 or more per square foot and vary widely by market (Terrapin Construction Group, 2026). The spread matters: on 2,400 square feet, $25 versus $70 per square foot is a $108,000 difference. Read how to negotiate TI allowances or use the TI allowance calculator.

Whether the suite can take dental plumbing, power, HVAC, vacuum and compressor loads; the TI allowance and how it is repaid; rent escalations and operating costs; renewal options; and what you owe when you leave. Space is tight: JLL reported record medical office occupancy of 92.7% in late 2025 (JLL, 2026). Price the build-out first, then let your attorney review the lease. See the real estate guide.

Yes. The single-purpose calculators are free and ungated: DSCR, loan payment, operatory square footage, TI allowance and a Section 179 educational estimate. Each explains how it calculates, and none produces a total project budget. The full cost estimator on the home page is also free; it asks for your name, city and state, email and phone before it unlocks. Start at the calculators page or the cost estimator.

Two places, always labeled. Model figures, such as $170 per square foot for standard leased construction and a 15-year loan at 8.25%, are Alithos planning assumptions, published in full on the dental office cost benchmark. Market figures come from cited primary or reputable sources, such as the IRS, SBA, ADA and JLL, and are rechecked when a page is updated. The editorial policy explains how.