Los Angeles-based Cal Dental USA expanded when COVID-19 disrupted dentistry. As the healthcare landscape shifts again, its leadership is changing the playbook — and betting that knowing when to move may matter more than being the biggest.
In March 2020, American dentistry essentially stopped. As COVID-19 spread across the U.S., dental offices postponed most non-emergency procedures, patient traffic collapsed and practice owners faced an economic shock few could have anticipated.
For many dentists, it was a crisis. For Cal Dental USA, it eventually became an acquisition opportunity. Six years later, the Southern California dental organization sits at No. 222 on the 2026 Inc. 5000, reporting 1,545% three-year revenue growth.
But the more interesting story may not be how much Cal Dental USA grew. It’s when it chose to grow — and when it decided to change direction.
“Timing has probably been one of the greatest assets our leadership team has had,” said James Jones, CEO of Cal Dental USA. “We’ve never claimed we’re going to be the largest DSO in America. What we’ve tried to become very good at is recognizing when the market is changing and having the ability to move quickly.”
When the market pulled back, Cal Dental USA bought
The pandemic created conditions rarely seen in dentistry. Practices that had historically generated predictable cash flow suddenly faced closures, reduced patient volume, staffing challenges and uncertainty about when normal operations would return.
Cal Dental USA had something particularly valuable at that moment: available capital. Instead of waiting for stability, the organization went on offense. Working alongside founder John Kim, DDS, COO Eddie Kim and the broader leadership team, Cal Dental USA accelerated its expansion across Southern California, eventually building a network of roughly two dozen locations.
Some acquisitions were conventional. Others weren’t.
“We literally had opportunities where offices were being handed to us,” Mr. Jones said. “Owners were tired, doctors wanted out and the economics of some of these transactions had completely changed.”
Cal Dental USA believed that despite the immediate disruption, many of the underlying practices still contained long-term value. The organization also had another advantage: it wasn’t dependent on outside institutional capital to execute its strategy.
“We had capital available at a moment when capital mattered,” Jones said.
Cal Dental USA bought while much of the market was defensive. Five years later, leadership believed it was seeing another significant shift. This time, its response was almost the opposite.
When the market changed, Cal Dental USA sold
By 2025, the healthcare environment was changing again, and Cal Dental USA’s leadership was watching several developments simultaneously.
The federal reconciliation law enacted in July 2025 made substantial changes to Medicaid eligibility, enrollment and financing. The Congressional Budget Office has estimated that the Medicaid provisions will reduce federal deficits by hundreds of billions of dollars over the 2025–2034 period and reduce Medicaid enrollment over time.
California was confronting changes of its own. The state has changed Medi-Cal eligibility rules for some adults based on immigration status, and the California Department of Healthcare Services says that beginning July 1, some adult Medi-Cal members who do not qualify for federally funded full-scope Medi-Cal will lose routine dental coverage while retaining emergency dental services.
At the same time, intensified federal immigration enforcement began affecting parts of Southern California. Immigration raids across Los Angeles in 2025 produced visible economic disruption in some immigrant-heavy communities. Reuters reported sharp declines in customer traffic at some Los Angeles businesses as workers and customers stayed home amid concerns about enforcement.
For Cal Dental USA — an organization concentrated in Southern California and serving diverse communities — leadership viewed these developments as business signals worth monitoring.
Medicaid and Medi-Cal policy was changing. The payer environment was evolving. Immigration enforcement was affecting behavior in some communities. Those factors raised questions about how the economics of individual dental practices could change with them.
Cal Dental USA leadership began asking a different question: What happens to the economics of an individual dental practice when the population, reimbursement environment or patient behavior around it changes?
“We could see another shift forming,” Mr. Jones said. “This wasn’t about politics for us. We’re healthcare operators. Our responsibility on the business side is to understand what could affect our patients, our doctors, our employees and the long-term health of the organization.”
Rather than wait for every potential effect to materialize, Cal Dental USA began reducing portions of its ownership exposure.
Working with First Choice Practice Sales and All In Capital Realty, the organization began divesting practices from its owned portfolio. The strategy encompassed approximately 12 locations. Five years earlier, Cal Dental USA had been buying. Now, it was selling. To leadership, those weren’t contradictory decisions. They were responses to two different markets.
From owning practices to building a platform
Selling practices doesn’t necessarily mean Cal Dental USA is leaving them behind. Some locations can transition to new ownership while maintaining relationships with the organization through management or affiliation agreements. That represents the next evolution of Cal Dental USA’s strategy — from accumulating practices to building infrastructure around them.
The company’s evolving management services and affiliation strategy has been spearheaded by Strategic Growth Advisor Ian Miller, with the broader leadership team focused on developing systems that can support independent dental practices without Cal Dental USA necessarily owning them.
Under the model, the organization can provide operational, marketing, administrative and other non-clinical support to affiliated practices. The company has also expanded the infrastructure surrounding its network, including an internal dental laboratory and real estate capabilities through its relationship with All In Capital Realty.
“The old thinking was that if we wanted to grow, we had to own another office,” Mr. Jones said. “We’re learning that ownership and infrastructure don’t have to be the same thing.”
That shift could allow Cal Dental USA to expand its reach while committing less acquisition capital to each individual practice. It also reflects an important distinction in the organization’s leadership structure.
Founder Dr. Kim recently marked 40 years as a licensed dentist, bringing four decades of clinical experience to a company navigating a dramatically different dental landscape from the one in which he began practicing. Cal Dental USA’s clinical leadership also includes Lead Dentist Ki Lee, DDS, who leads on the clinical side and works alongside the organization’s doctors to support quality patient care. Mr. Jones, meanwhile, leads the broader business strategy, growth and capital allocation.
“One of our strengths is knowing where each of us brings the most value,” Mr. Jones said. “My focus is building the business, creating opportunities and making sure our doctors have the resources and infrastructure behind them. Dr. Lee and our clinical team focus on dentistry and patient care. When both sides are strong and working together, that’s when the organization is at its best.”
The distinction becomes increasingly important as Cal Dental USA expands through affiliations rather than traditional ownership alone. A dentist doesn’t necessarily need Cal Dental USA to own a practice for the organization to provide business infrastructure around it. And Cal Dental USA doesn’t need to direct clinical decision-making to build a larger business platform.
The advantage of staying flexible
The ability to make two dramatically different moves within five years — first buying, and later selling — points to another element of Cal Dental USA’s strategy.
The organization has grown primarily with its own capital rather than building its expansion around traditional institutional venture capital funding. Outside investment can provide healthcare organizations with substantial resources to acquire practices and build infrastructure quickly. It can also bring investment horizons, return expectations and requirements surrounding the deployment of capital.
Cal Dental USA chose a different path.
“We’ve grown primarily with our own capital,” Mr. Jones said. “That can mean you don’t grow as fast as somebody who raises hundreds of millions of dollars. But it also means when we believe the market has changed, we can change.”
For Cal Dental USA, the advantage is optionality. The company could be an aggressive buyer during the disruption of 2020 without committing itself to being an aggressive buyer forever.
That same philosophy now underpins its move toward affiliations. Instead of measuring growth exclusively by the number of practices it owns, Cal Dental USA is increasingly looking at how many practices its infrastructure can support.
No. 222 is the result, not the strategy
That context makes Cal Dental USA’s latest Inc. 5000 ranking more meaningful to its leadership.
The company reached No. 222 nationally in 2026 with reported three-year revenue growth of 1,545%, after ranking No. 4,527 a year earlier.
But leadership doesn’t view the ranking as a mandate to simply keep acquiring locations. Its strategy assumes that what worked yesterday may not work tomorrow. What makes sense in one market may not make sense in another. And owning more practices isn’t automatically better if capital and infrastructure can produce value in other ways.
“People sometimes think timing the market means predicting exactly what’s going to happen,” Mr. Jones said. “That’s not how we look at it. You watch what’s happening around you. You protect your capital. You understand your patient population. And when the facts change, you can’t be afraid to change your strategy.”
Timing over size
Cal Dental USA isn’t abandoning acquisitions. It isn’t arguing that traditional practice ownership no longer works. And its leadership isn’t claiming it can perfectly predict where dentistry goes next. Instead, the company is trying to preserve its ability to choose.
During one of the greatest disruptions dentistry had experienced in decades, Cal Dental USA saw an unusual acquisition environment and bought. When leadership believed another shift was developing, it began selling portions of its portfolio and accelerating its transition toward management services and affiliations. Those decisions don’t guarantee that every market call will be right, but they illustrate the philosophy behind the company’s growth.
Cal Dental USA isn’t building its strategy around a race to own the most dental offices. It’s making a different bet: that in a changing healthcare market, flexibility itself can be an asset. In 2020, for Cal Dental USA, that meant buying. Five years later, it meant selling. And whatever comes next, leadership’s strategy remains remarkably simple: Pay attention, stay flexible and know when to move.
