> ## Documentation Index > Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt > Use this file to discover all available pages before exploring further. # Maryland CPOD and DSO reference > Corporate practice of dentistry status, professional entity forms, fee structure rules, noncompete law, and DSO-specific requirements in Maryland. Maryland is a **strict, express** corporate practice of dentistry (CPOD) state. Health Occupations § 4-103 requires a dental practice to be owned by a Maryland-licensed dentist or dental professional corporation, reserves specified decisions and economics to dentists, prohibits lay interference with professional judgment, and defines the support services an unlicensed person may provide. 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](/reference/legal/dental-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 $5,000 and one year for a first offense and 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](https://mso.getlemma.com/). ## 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 See [PC vs PLLC vs PA](/concepts/entities/pc-vs-pllc-vs-pa) and [Form a professional corporation](/guides/formation/form-a-pc). ## 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](/concepts/model/fee-splitting) and [Set the management fee](/guides/agreements/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](/reference/legal/dental-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: | Permitted support category | Statutory boundary | | ------------------------------------------------------------ | ---------------------------------------------------------------------------------------- | | Real property, equipment, fixtures, and furnishings | The ownership and clinical-control rules still apply | | Accounting, tax, payroll, and administrative-record services | Treatment-record creation, maintenance, and access remain reserved under § 4-103(B) | | Billing and collection | The dentist cannot share revenue or split fees outside the statutory exception | | Dentist-approved advertising and marketing | The practice's licensed authority cannot be displaced | | Recruitment and nonprofessional staffing | Clinical hiring, supervision, discipline, and termination remain with a licensed dentist | | Human resources and information technology | Services do not include control of independent professional judgment | | Property management | Subject to the same ownership and control limits | | Risk management, compliance, and insurance | Advice and administration do not transfer clinical authority | | Productivity and cost-containment consulting | The consultant cannot direct treatment or clinical staffing | | Subcontracted support | Compensation and substantive boundaries continue to apply | 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 | Source | What it covers | | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------- | | [HO § 4-103](https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gho\§ion=4-103) | Express ownership rule; dentist-reserved powers; noninterference; fee rule; permitted support services and exceptions | | [H.B. 939 / 2020 Md. Laws ch. 379](https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/HB0939?ys=2020RS) · [enacted text](https://mgaleg.maryland.gov/2020RS/Chapters_noln/CH_379_hb0939t.pdf) | Enactment history and October 1, 2020 effective date | | [HO § 4-101](https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gho\§ion=4-101\&enactments=false) | "Practice dentistry" definition | | [HO § 4-301](https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gho\§ion=4-301\&enactments=false) | License requirement; heir/personal-representative exemption | | [HO § 4-601](https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gho\§ion=4-601\&enactments=false) | Unlicensed-practice prohibition | | [HO § 4-606](https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gho\§ion=4-606\&enactments=false) | Felony penalties | | [CA § 5-101](https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gca\§ion=5-101\&enactments=false) | Professional service corporations; dentists enumerated | | [CA § 5-109](https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gca\§ion=5-109\&enactments=false) | Licensee-only stock; violating issuances void | For the cases and statutes referenced above, see [DSO & dental case law](/reference/legal/dso-case-law) and the [51-jurisdiction table](/reference/legal/dso-laws-by-state). For enacted and pending legislation, see the [dental legislation tracker](/reference/legal/dental-legislation-tracker).