Texas dental law comes from the Occupations Code, State Board of Dental Examiners rules, the ch. 73 registration statute, and case law. Check the legislation tracker for pending changes.
1. CPOD status
Tier: Strict Texas restricts ownership through the definition of practice rather than a standalone ownership section. Under Tex. Occ. Code § 251.003(a)(4), a person practices dentistry if the person “owns, maintains, or operates an office or place of business in which the person employs or engages under any type of contract another person to practice dentistry.”1 Interfering with a dentist’s professional judgment is also practicing dentistry (§ 251.003(a)(9)).1 Practicing without a license violates Tex. Occ. Code § 256.001. The violation is a felony of the third degree, with each day a separate offense (Tex. Occ. Code § 264.151(a)).2 A lay entity that moves from support into ownership or control therefore faces potential criminal as well as civil consequences. The case law is the heart of Texas CPOD:- Penny v. Orthalliance, Inc., 255 F. Supp. 2d 579 (N.D. Tex. 2003): the court read the asset-purchase, service, and employment agreements together and held that they let the DSO “own, operate, and maintain” offices where it employed orthodontists. That arrangement violated §§ 251.003(a)(4) and 256.001, and the agreements were void in their entirety.3
- In re OCA, Inc., 552 F.3d 413 (5th Cir. 2008): the Fifth Circuit analyzed 40-year business-services agreements under which OCA controlled facilities, finances, marketing, and work hours. It held the agreements illegal and unenforceable under the Texas statutes based on the aggregate rights before it. The opinion does not establish a compliant fee, term, or document form.3
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
Texas dentists practice through professional associations, professional corporations, or PLLCs under Tex. Bus. Orgs. Code title 7 (chs. 301–303). Joint dentist–physician entities are permitted in specified cases. Verify the pinpoints with counsel before relying on that route. 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
The Occupations Code does not contain a blanket percentage-MSA sentence, but Board rule 22 TAC § 108.70 imposes targeted pricing rules. A dental-office space lease from a non-dentist must be written, set in advance, consistent with fair market value, and not determined by a percentage of revenue or receipts; an equipment lease likewise may not be percentage-based and must leave the equipment in the dentist’s care, custody, and control. The rule also bars a management fee conditioned on referrals. Beyond those specific clauses, Penny and In re OCA read the fee, term, and control provisions together; owner-like economics support the conclusion that the DSO owns, maintains, or operates the office under § 251.003(a)(4). Section 108.70’s control list is an MSA diligence checklist: a non-dentist may not control or attempt to control clinical decisions, patient records, hiring/firing/compensation of dental personnel, practice hours, clinical equipment or supplies, professional training, treatment presentation, or other enumerated practice matters. Check the current Texas Administrative Code text rather than relying on an older Board compilation. 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
Dentist noncompetes in Texas are governed by the state’s general covenant-not-to-compete law; Texas has statutory requirements specific to physician covenants whose application to dentists you should verify with counsel before drafting. 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
Texas has a dental-specific DSO statute: Tex. Bus. & Com. Code ch. 73, “Registration of Dental Support Organizations,” added by S.B. 519 (84th Leg., R.S., Acts 2015, ch. 603), effective September 1, 2015, with first registrations required beginning February 1, 2016.4
Registration is a public-disclosure requirement, not licensure or approval. Filing does not cure an arrangement that violates § 251.003(a)(4). See Register a DSO for the filing workflow.
7. Death and transition window
No statutory estate or transition window was verified in the Dental Practice Act for this page. Texas board rules address custodianship of records after a dentist’s death. Verify current succession mechanics with counsel and see Plan for succession.8. Practical structuring notes
Read Penny and OCA as whole-arrangement cases. The challenged agreements combined long terms, financial rights, facilities, staffing, hours, and other controls. For a proposed arrangement, identify the actual employer, contracting and billing provider, asset owner, decision maker, fee methodology, termination rights, and operational conduct; then test the combined effect under current Texas statutes and rules. Fair-market-value evidence or a clinical carve-out does not cure a separate ownership or control violation. Calendar the ch. 73 filing. The January 31 annual deadline, the 90-day new-agreement deadline, and the daily-accruing penalty make this a compliance calendar item, not a one-time formation task. The filing also publicly names every ≥10% owner and every supported dentist, so structure with the expectation that the relationship map is visible to the board.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
Entity formation and good standing run through the Texas Secretary of State; board rules through the Texas State Board of Dental Examiners; pending bills through the Texas legislature’s tracker.
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.