Five kinds of help plan dental offices: equipment dealer design teams (paid through the equipment order), design-build firms (paid through construction), dental startup consultants (many do not publish fees), independent flat-fee budget planners such as Alithos Advisory (published fees: $2,500 Feasibility Check, $7,500 to $10,000 Budget Plan) and doing it yourself. The right choice depends on who checks the total budget before you sign.
I run Alithos Advisory, so I am one of the options on this page. Judge me by the same test I give everyone else: how am I paid, what do I deliver, and what do I not do? My answers are in writing below. If another option fits your project better, this guide should help you see that.
A dental office is a stack of six-figure decisions made in a few months. An ADA News expert column says opening a practice often takes $500,000 at minimum (3). The Alithos estimator puts a 4-operatory startup in leased space at standard finish at about $746,000 to $824,000 all-in, including $85,000 of working capital (5). That is planning math, not a quote. Plenty of people will help you plan it. The useful question is not "who is best?" It is "who is checking the whole number, and how are they paid?"
What are your options?
Here is how the five options compare on the things that decide whether your budget gets an independent check. "Built-in conflict" is not a judgment about anyone's honesty. It describes what the payment model rewards.
| Dealer design | Design-build | Startup consultant | Independent budget planner | DIY | |
|---|---|---|---|---|---|
| How paid | Usually the margin on the equipment order; no separate design fee | Fee and profit inside the design-and-construction contract | Varies: program fee, hourly, percentage, sometimes vendor referrals; ask | Flat fee paid by you alone | Your time |
| What you get | Floor plan, equipment layout and utility specs, equipment package | Design and construction under one contract | Varies widely, from coaching to a full startup program | Total project budget, financing math, lender-ready package | Whatever you build yourself |
| Who checks the total budget | Not their scope; they price the equipment | The firm checks its own construction price | Depends on the scope you buy | The planner; that is the deliverable | You |
| Built-in conflict | A larger order pays more | The firm scopes and prices the work it will build | Any vendor referral fee; ask in writing | None from vendors; you still need your own architect, contractor, attorney and CPA | No one checks your blind spots |
| Paid by the sale of what it recommends | Yes | Yes | Ask | No | Not applicable |
| Best for | Equipment layout once your budget is set | Owners who value one point of responsibility and a faster start | Owners who want a guided program and confirm how the consultant is paid | Owners who want the full number checked before signing | Acquisitions with no build-out |
None of these is wrong on its own. Most good projects use two or three of them. The trouble starts when the same party designs the project, prices it and sells it, and nobody else checks the total.
What does each option cost?
Every option costs something. Some costs are visible on an invoice. Others sit inside a price you pay for something else.
| Option | What you see | Where the cost actually sits |
|---|---|---|
| Dealer design | "Free" | Usually recovered in the equipment margin. Some programs tie the design to a purchase commitment or charge a design fee if you buy elsewhere. |
| Design-build | One contract price | Design is folded into the construction fee, so it is hard to see on its own. |
| Startup consultant | Often not published | A program fee, hourly billing, a percentage of the project, or vendor referral fees. Ask for the model in writing. |
| Alithos Advisory | Published | Feasibility Check $2,500 flat (credits toward the Budget Plan). The Budget Plan $7,500–$10,000 flat fee, scope in writing. Project Navigator from $20,000, quoted per project; availability depends on your project's state. |
| DIY | $0 | Your hours, and the price of mistakes no one caught. |
For scale: on the estimator's 4-op lease standard project ($746,000 to $824,000), a $7,500 to $10,000 Budget Plan is about 0.9% to 1.3% of the total. I am not quoting consultant prices here because I have not found published, citable price lists. If you want the deeper look at consultant fees, read what a dental startup consultant should cost.
What does dealer design do well?
Dealer design teams do real work, and a lot of it is good. Give them fair credit:
- Equipment knowledge. They know chairs, delivery systems, imaging and sterilization equipment in detail, including what each piece needs from the room.
- Utility specs. Chairs, compressors, vacuum and imaging have plumbing, electrical and data requirements. Dealer teams produce those specs, and your architect and contractor need them.
- Clinical flow. Good designers have laid out many operatories and sterilization areas. They notice workflow problems early.
- Install coordination. Someone has to schedule delivery and installation around construction. The dealer usually does.
The limit is scope, not skill. A dealer prices the equipment it sells. That is a large slice of the project (one dental lawyer's 2026 guide says equipment for a standard build alone is often $100,000 to $200,000 (4)), but it is not the lease, the construction, the soft costs, the loan or the working capital. And when the designer and the seller are the same company, there is no natural moment for a second quote.
Dealer pricing has also been in front of regulators. In 2019 an FTC administrative law judge ruled that two of the largest dental distributors had conspired to refuse discounts to dental buying groups (1). That says nothing about any dealer's conduct today. It is a reason to get your own number first. More in the "free" office design isn't free and the dental equipment cost guide.
When does design-build make sense?
The Design-Build Institute of America describes the core of design-build as a single contract for both design and construction (2). You hire one firm. It brings the designer and the builder, and it answers for both.
That can be a good fit when:
- You want one point of responsibility instead of refereeing an architect and a contractor.
- Speed matters, because design and pricing can overlap instead of running in sequence.
- The firm has built dental offices before and can show you how it prices allowances and changes.
The tradeoff is the check. In design-bid-build, an architect designs and several contractors bid the same drawings. In design-build, the firm that scopes the work is the firm that prices and builds it. You can still keep a check in place: set your budget first, ask for an open-book cost breakdown, and have someone independent review the price and the change orders. The full tradeoff is in design-build vs. design-bid-build.
What does a dental startup consultant do?
"Dental startup consultant" covers a wide range. Some teach seminars and give you a toolkit. Some coach you through site selection, lenders and hiring. Some run a full startup program that coordinates vendors for you over many months. Many do not publish their fees, and fee models vary: a fixed program fee, hourly billing, a percentage of the project, or a mix.
A good consultant can save you from first-timer mistakes, especially on marketing, hiring and opening operations, which are outside what I do. The question to settle early is whether any part of their income comes from the vendors they recommend. That is not automatically wrong, but you should know it in writing before you take a referral to a dealer, lender, broker or contractor.
If you are weighing whether you need one at all, read do you need a startup consultant? and the full how to open a dental practice guide.
What does an independent budget planner do, and not do?
An independent budget planner builds and checks the total project number before you commit to it. That is what Alithos does. I am paid a flat fee by you alone. I take no commissions, referral fees or kickbacks from lenders, dealers, brokers or contractors, in either direction.
Feasibility Check · $2,500
A go / no-go financial screen: space and site fit, a high-level equipment budget range, and a DSCR pre-check against the 1.25× coverage lenders commonly look for. Credits toward the Budget Plan.
The Budget Plan · $7,500–$10,000
Space requirements, a line-item equipment and imaging budget, build vs. lease vs. condo projections, Section 179 and tax modeling, cash-flow and debt-service coverage analysis, and a lender-ready package. Most are completed in 3–5 weeks.
Project Navigator · from $20,000
The Budget Plan plus owner-side advisory through opening: independent quote review, floor plan and design review against the budget, lender negotiation support, and change-order review. Quoted per project; availability depends on your project's state, confirmed before engagement.
What I do not do matters just as much. I am not a contractor, architect, engineer, real estate broker, lender, attorney, CPA or investment adviser. I do not draw your plans, build your office, give legal advice on your lease or prepare your taxes. Your architect designs. Your contractor builds. Your attorney reviews the lease and contracts before you sign. Your CPA confirms the tax treatment. I make sure the numbers all those people produce add up to a project your practice can carry.
The details are on the services page, including the Feasibility Check, the Budget Plan and Project Navigator.
Can you plan it yourself?
Sometimes, yes. Doing it yourself is reasonable when the facility is not really the project:
- You are buying a healthy practice with clean books and keeping the space as it is.
- The only equipment change is a planned replacement you have priced before.
- You already have a dental CPA and a dental attorney on the deal.
In that case, spend the money on working capital. A planner earns the fee where the facility is the project: startups, relocations, expansions and ground-up builds, where construction, equipment and lease decisions stack up faster than a working dentist can check them. If you go it alone, start with the cost estimator and the startup cost guide so you at least know the shape of the number.
How do you combine them?
The options work best in a set order. The order is what protects you.
- Set the budget first. Fix your operatory count, square footage, equipment budget and total project cost from your own production and financing math, before any dealer meeting or lease tour.
- Invite dealer design as a proposal. Let the dealer design against your budget. Treat the plan as a proposal to be measured, not the document that becomes your plan by default.
- Get two or three quotes. Ask two or three dealers to quote the same equipment list, and get competing contractor bids on the same drawings (or an open-book price if you chose design-build).
- Have the quotes checked. Compare each quote line by line against the budget, with your own review or an independent quote review.
- Track the budget to opening. Review every change order against the plan before you approve it.
A prepared buyer gets cleaner quotes, because everyone is pricing the same list against the same number. The detail on step two is in how to use free dealer design safely.
What 12 questions should you ask any advisor?
Ask these of every dealer, design-build firm, consultant and planner, including me. Ask for the answers in writing.
- How are you paid on my project, in writing?
- Do you take referral fees, commissions or rebates from anyone you recommend, in either direction?
- Is your price published? If not, what is it before a sales call?
- Is the fee flat, hourly or a percentage of the project?
- What exactly will I receive? Send me the deliverable list.
- What do you not do?
- Who owns the work product, and can I share it with other dealers, contractors and lenders?
- Will you show me the total project budget, or only your part of it?
- Do you check the numbers other parties give me, or only produce your own?
- What licenses do you hold, and which professionals will I still need to hire?
- When do you start and stop, and what does it cost to end the engagement early?
- Can I see a sample of a deliverable with client details removed?
Clear, specific answers are a good sign. "We handle everything" usually means a cost is sitting somewhere you cannot see.
Frequently asked questions
Is free dental office design really free?
No. Dealer design has no separate fee, but its cost is usually recovered in the margin on the equipment order that follows, and some programs tie the design to a purchase commitment. The design can still be good work. Use it as a proposal measured against a budget you set first.
What is an owner's representative for a dental office?
An owner's representative is someone who works for the owner, not for the builder or vendors, and looks after the owner's interests during a project. Some owner's reps also oversee construction for the owner. Alithos offers owner-side advisory, not construction management: independent quote review, design review against the budget and change-order review, through Project Navigator where it is available in your project's state.
Do I need a consultant if my dealer is designing my office?
Not always. The dealer designs the layout and prices the equipment it sells. Someone still needs to check the total budget, including construction, lease, soft costs, financing and working capital. If you can do that yourself, you may not need help. If not, get it checked before you sign.
How are dental startup consultants paid?
It varies. Common models are a fixed program fee, hourly billing, a percentage of the project, or a mix, and some may also receive referral fees from vendors. Many do not publish prices. Ask every consultant to state in writing how they are paid and by whom.
Can I use an independent planner and a design-build firm together?
Yes. Set the budget with the planner first, then hire the design-build firm to design and build within it. The planner can review the firm's price, allowances and change orders against the budget. The firm stays responsible for design and construction.
What should I ask before hiring a dental startup consultant?
Ask how they are paid, in writing; whether they take referral fees from anyone they recommend; what the fee is and whether it is published; what they deliver and what they do not do; who owns the work product; and which licensed professionals you will still need.
Want your own number before you pick a team? Run the cost estimator, or book a free Project Fit Call and ask me any of the 12 questions above. More guides are in the guides library.
How we research and update this page. Market figures come from the sources listed below. Alithos prices and model numbers come from this site. No planning provider is named or rated. Read the editorial policy.
Sources
- Federal Trade Commission, Docket No. 9379, Initial Decision of the Administrative Law Judge (2019). ftc.gov
- Design-Build Institute of America, "What is Design-Build?" (accessed 2026). dbia.org
- ADA News, "Ask the Expert: How to be financially prepared for practice ownership" (2025). adanews.ada.org
- Dental & Medical Counsel (A. Oromchian), "A Dental Lawyer's Guide to Your Dental Office Build-Out" (2026). dmcounsel.com
- Alithos Advisory, cost benchmark and estimator assumptions (2026). Planning model, not a quote. alithos.co