Episode 56 · Lane Theriault · 1 Sep 2026 · 46 min

    Building an 80-practice DSO

    A second dental roll-up built on practice autonomy, not a rigid playbook, and an AI stack built in-house instead of bought.

    Featured guest

    Lane Theriault

    CEO, Independence Dental Services
    Lane Theriault is CEO of Independence Dental Services, a US dental support organization he built from eight practices in 2020 to around eighty today. He spent his early career in M&A at Citigroup before co-founding 123Dentist, one of Canada's largest dental groups, in 2017.
    There's no sense in adding marketing spend to a leaky bucket.
    Lane Theriault

    Show notes

    Lane Theriault isn't a dentist, he's an investment banker who spent his early career in M&A at Citigroup before co-founding 123Dentist, one of Canada's largest dental groups, in 2017. When a private equity transaction gave him a clean exit in 2019, he moved to the US to build a second DSO rather than compete with his old company, launching Independence Dental Services with eight practices at the end of 2020. Five years on, Independence has grown to around eighty practices, using a model built on preserving each practice's autonomy rather than forcing one playbook onto everyone.

    Much of the conversation digs into what that autonomy actually means in practice, from recruiting, Independence's biggest and hardest support function, to marketing, where Lane argues spend is wasted until a practice fixes its 'leaky bucket,' his own term for a business that can't convert or retain the patients it's already attracting.

    The back half of the episode turns to how Independence uses AI, not by buying a stack of point solutions, but by building a searchable knowledge base from its own emails, calls and documents, then layering narrow, low-risk automations on top, all the way up to an in-house AI voice receptionist that Lane insists has to openly identify itself as AI to actually work.

    Key takeaways

    • Independence Dental's "supported autonomy" model lets each partner practice keep its own clinical and business identity, and even lets two practices in the same market run completely different strategies.
    • Recruiting is Independence's biggest support function, and the hardest part isn't finding doctors, it's finding dental assistants and other clinical staff in a market now competing with employers like Buc-ee's on pay and flexible hours.
    • Marketing spend is wasted on a "leaky bucket," Lane's term for a practice that can't convert or retain the patients it already attracts, so fixing call handling and schedule efficiency comes before increasing ad spend.
    • Search ads tend to outperform low-intent channels like social, and Independence often coaches partners to double their spend once the underlying conversion math actually holds up.
    • Consolidation economics have shifted, high-quality acquisition targets no longer trade at a discount to platform value, so Independence has slowed its buying and is prioritizing organic growth at practices it already owns.
    • Real AI adoption starts with a searchable knowledge base built from an organization's own emails, calls and documents, not a single vendor purchase, with compliance and data-handling rules established before anything gets built.
    • Independence built its own AI voice receptionist after finding third-party versions underwhelming, and had it explicitly identify itself as AI, since patients who felt deceived hung up, while patients told upfront were far more willing to engage.
    Stop the leak

    See how much revenue your clinic is leaking.

    Coherent gives private clinics one patient relationship engine, recovering revenue lost at enquiry, recall and billing.