North Dakota’s rules appear in a single chapter, N.D.C.C. ch. 43-28. Check the legislation tracker for pending changes.
1. CPOD status
Tier: Hybrid, with a statutory dentist-majority ceiling and a separate entity-form analysis- § 43-28-25(3) makes it a class A misdemeanor “[f]or any person, except a dentist, to own more than forty-nine percent of an office practice or business at which the practice of dentistry is performed.” It establishes a criminal ceiling; it does not say that every entity statute permits a lay minority interest.
- Exceptions: a board-approved medical clinic, hospital, or public health setting with which a dentist is associated; a board-approved nonprofit serving an underserved population; and the heir or personal representative of a deceased dentist.
- The “practice of dentistry” definition is clinical and contains no proprietor clause (§ 43-28-01(7)). The license requirement appears in § 43-28-10. The board may seek an injunction without proof of damages.
- § 43-28-18(5) makes it a disciplinary ground for a dentist to employ or permit an unlicensed individual to practice dentistry in an office under the dentist’s control.
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. A hygienist is a non-dentist for purposes of the 49% criminal ceiling. Whether a hygienist may hold the proposed interest in the chosen entity form is a separate question.3. Professional entity forms
Permitted forms: Professional entity formation generally runs under the North Dakota Professional Organizations Act (N.D.C.C. ch. 10-31). Do not infer a lay-ownership safe harbor from § 43-28-25(3): § 10-31-04(3)‘s minority-owner exception expressly names architecture/landscape architecture and accounting statutes, not dentistry under ch. 43-28. Counsel should reconcile the Dental Practice Act with the exact corporation or LLC form selected. Ownership: more than 49% lay ownership is criminally prohibited. Whether a lay interest of 49% or less is valid, and through which entity form, requires separate analysis. 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-splitting and management-fee structure
Fee splitting with non-dentists is a disciplinary ground (§ 43-28-18(9)), although the statute expressly permits partnership fee sharing among dentists and employment of dentists and hygienists. A percentage-of-revenue management fee paid to a lay DSO may be characterized as split fees. A fixed or cost-plus fee avoids that percentage feature but still requires fair-market-value and control review. Do not treat a distribution to a purported 49% lay investor as valid until counsel confirms that the chosen entity law permits the underlying interest. 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. Dentist noncompetes
No dental-specific noncompete statute was identified in the sources used for this page. Enforceability depends on North Dakota’s general restrictive-covenant law, which is restrictive. Verify the provision with counsel before including it. 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
No DSO-specific registration. No registration or disclosure regime for dental support organizations appears in ch. 43-28. A professional organization still has an entity filing: § 10-31-13 requires an annual report to the Secretary of State and a copy to the profession’s regulating board. Separately, § 43-28-28 authorizes dental providers to negotiate jointly with dental insurers through an attorney-general-supervised process. For states that require DSO registration, see Register a DSO.7. Death and transition window
The heir or personal representative of a deceased dentist may operate the office under the deceased dentist’s name for up to two years from death (§ 43-28-25(3)). See Plan for succession.8. Practical structuring notes
A 49% interest still requires entity-law analysis. The Dental Practice Act identifies the level of lay ownership that is criminal, while the selected entity statute determines whether the interest may be issued. If a valid route exists, the dentist majority and control must be genuine. Section 43-28-18(9)‘s fee-splitting restriction separately applies to payments characterized as fees.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 and where to verify
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.