Maryland’s current framework was enacted by H.B. 939, 2020 Md. Laws ch. 379, effective October 1, 2020. Use the current text of Health Occupations § 4-103 and check the legislation tracker for later changes.
1. CPOD status
Tier: Strict, with express ownership, control, and fee restrictions HO § 4-103(A) permits only a licensed dentist or dental professional corporation to own a dental practice. This is a direct ownership rule, not an inference from the heir exception. Under § 4-103(B), only a licensed dentist may take the statute’s reserved actions. They include directing clinical training and patient care; selecting, hiring, supervising, disciplining, and terminating dentists, dental hygienists, and dental assistants; directing the creation and maintenance of treatment records and access to them; and sharing in the practice’s income, revenues, profits, or fees. Section 4-103(C) separately prohibits a dentist from sharing revenue or splitting fees except as the section permits, and § 4-103(D) prohibits a non-dentist from directing, controlling, or interfering with a dentist’s or hygienist’s independent professional judgment. The criminal backstop is significant. Unlicensed practice is a felony under HO § 4-606(a), punishable by up to 20,000 per day and five years for a subsequent offense.2. Other professions
This page covers dentistry only. Medicine, optometry, veterinary practice, and other professions are governed by different statutes and boards, even within the same state. For medical-practice sources, use the MSO-PC Wiki.3. Professional entity forms
Express owner forms: a Maryland-licensed dentist or dental professional corporation under HO § 4-103(A). Dentists are an enumerated profession under the Maryland Professional Service Corporation Act (Md. Code, Corps. & Ass’ns § 5-101). Under CA § 5-109, stock may be issued only to qualified licensed persons, qualified general partnerships, or same-service professional corporations, and stock issued in violation is void. The availability of an ordinary LLC as a general entity form does not establish that it may own a dental practice; reconcile any proposed alternative form with § 4-103(A). Ownership: hygienists are not “qualified” to hold stock in a dental PC under the PC act, and no dental-act authorization for hygienist practice ownership was located. Verify the point with counsel. Also confirm before filing:- Naming rules, designator requirements, and any limits tied to licensed owners’ names; several states regulate dental trade names separately
- Board pre-approval or certificates, whether the dental board must act before (or after) the secretary of state will file
- Officer and director licensure, including states that restrict these roles as well as ownership to licensees
4. Fee structure
Maryland does not leave the support fee to inference. HO § 4-103(E)(14) allows compensation for the section’s permitted support services only as a predetermined fixed fee or other predetermined fixed compensation. The amount may be based on the dental practice’s revenues or profits over a prior period of at least 12 months. Test the drafting against the exact statutory formula rather than using current-period collections as an automatic management-fee base. For the MSA, test whether a percentage-of-collections fee is permitted under the state’s dental, fee-splitting, referral, tax, and contract rules. Several states expressly restrict revenue-linked dental management fees, and the Aspen Dental settlements imposed related party-specific terms. Flat and cost-plus formulas are not automatic safe harbors; the services, calculation, amount, control rights, and actual payments still matter. See Fee-splitting rules and Set the management fee.5. Noncompetes
No dental-specific noncompete statute was identified in this research; Maryland noncompetes are governed by general state employment law. Verify current Maryland law with counsel before including one. Federal noncompete policy changed substantially in 2025 and 2026. The FTC’s Non-Compete Rule was vacated, the agency dismissed its appeals in September 2025, and the rule was removed from 16 C.F.R. pt. 910 effective February 12, 2026. State law remains central. Dental enforcement resolutions in New York and California have also restricted noncompetes for the settling parties as a corporate-practice remedy. Verify the current rule, worker, agreement type, transaction context, effective date, and remedy in this state. See the legislation tracker.6. DSO-specific law and registration
Maryland does not create a DSO registration filing in § 4-103, but it does create a detailed dental-management safe harbor. An unlicensed person may provide the following support without violating the section when the arrangement stays within its conditions:
The compensation must satisfy § 4-103(E)(14). Section 4-103(F) also contains specified institutional and statutory exceptions; test an asserted exemption against its exact text.
7. Death and transition window
Under HO § 4-301(b)–(c), an heir or personal representative of a deceased licensed dentist may own the practice, whether licensed or not, for up to one year after death. The Board may grant an extension of up to six months for good cause (§ 4-301(c)(1)). The owner may not interfere with dentists’ independent professional judgment, and licensed personnel must provide all patient care.8. Practical structuring notes
Maryland supplies both halves of the analysis in one section. Subsection (B) identifies matters only a dentist may control; subsection (E) identifies services a manager may provide. Build the MSA allocation, delegation matrix, employment structure, records access, and fee formula against those two lists. The § 4-301(b) heir exception is a separate transition rule, not the source of the ordinary ownership prohibition.9. Verification checklist
- Confirmed the permitted entity form for dentistry in this state
- Confirmed whether dental board pre-approval or a certificate is required before filing
- Confirmed whether officers and directors must be licensed dentists
- Confirmed the management fee structure is lawful here, including any restriction on revenue-linked fees
- Clinical carve-out drafted against this state’s current statutory language, including any enumerated control prohibitions
- Transfer restriction and succession documents checked against this state’s death-transition window
- Noncompete provisions checked against current state law
- DSO foreign-qualified before it has employees here
- Any DSO registration, licensure, or disclosure obligation identified and calendared
- Trade-name and advertising-disclosure rules for dental practices checked
10. Sources
For the cases and statutes referenced above, see DSO & dental case law and the 51-jurisdiction table. For enacted and pending legislation, see the dental legislation tracker.