The Complete Guide to Choosing a Dental CPA
Choosing a CPA is one of the biggest financial decisions you’ll make as a practice owner. The right one can save you tens of thousands of dollars a year. The wrong one files an accurate return and leaves that money on the table, year after year, without you ever knowing.
This guide is for dentists who own a practice, or are about to, and want to know what to look for. It covers what a dental CPA actually does, how to tell a tax prepare from a tax planner, what it should cost, the red flags to avoid, and how to switch if your current CPA isn’t the right fit.
The short answer: choose a CPA who knows dental practices, plans your taxes during the year instead of only filing them, talks to you before December 31, and can show you in dollars what they’ve saved clients like you.
What does a dental CPA do that a general CPA may not?
A dental CPA knows how dental practices make money, spend it and grow, and plans your taxes around that. A general CPA can file a correct return for almost any business, but often misses the moves that matter most to a practice owner.
A CPA who works with dentists every day should know:
- How dental income really works: collections versus production, insurance write-offs, and what a healthy overhead looks like for a general practice.
- The biggest equipment write-offs: CBCT machines, scanners, CAD/CAM, operatory build-outs, and when to buy so the deduction lands in the right year.
- How to pay you as an owner: whether an S-Corp election makes sense, and how to set a salary the IRS will accept for your clinical and management work.
- Retirement plans that fit a practice: 401(k) and profit sharing, and when a cash balance plan can shelter much more for an owner over 45.
- The rules for specialists like you: dentistry is a “specified service” for the 20% QBI deduction, so the deduction phases out at higher incomes unless your taxable income is managed.
- Practice transitions: buying a practice, bringing in a partner, or selling to a DSO, where the deal structure decides the tax bill.
Do you need a dental CPA?
If you’re an associate with a simple W-2, probably not yet. Once you own a practice, or a share of one, a specialized CPA usually pays for itself. These are the signs you’ve outgrown your current setup:
- You only hear from your CPA at tax time.
- Nobody has compared your entity with an S-Corp using your real numbers.
- You’ve never been shown a tax projection before December 31.
- You bought major equipment and weren’t told which year it would save you the most.
- Your retirement plan was set up by default, not designed for your age and staff.
- You’re planning to buy, add a partner or sell, and nobody has talked about the tax side.
- You owe more every April and can’t explain why.
If two or more sound familiar, it’s worth a second opinion.
What should you look for in a dental CPA?
The best dental CPAs combine industry knowledge, year-round planning and clear communication. Use these seven points to compare firms.
1. Real experience with dental practices
Ask how many dental clients they work with and what size practices. A firm that serves general practices doing $750K to $10M a year will know the patterns, and the opportunities, that a firm with one dental client won’t.
2. Proactive tax planning, not just tax preparation
The most important question: will they help you lower next year’s taxes, or only report last year’s? Look for a firm that builds a plan with you and checks it during the year.
3. Credentials beyond the CPA license
A CPA license is the baseline. Designations such as Certified Tax Coach or Certified Tax Planner show training focused on planning, not just compliance.
4. Year-round access and fast replies
Big decisions don’t wait for April: hiring an associate, buying a scanner, signing a lease. Ask how quickly they reply and whether you’ll be charged every time you call.
5. Clear, predictable pricing
A flat monthly fee lets you ask questions without watching the clock. Hourly billing can quietly discourage the conversations that save you the most.
6. Proof in dollars
Ask what they saved clients like you last year. A good firm can show real numbers and explain how they got them.
7. A good fit with you
You’ll share your income, plans and worries with this person for years. They should explain things in plain English and make you feel taken care of, not judged.
Tax prepare or tax planner: which one do you have?
A tax prepare records what already happened. A tax planner changes what happens. Both can file an accurate return, but only one can lower it.
| Tax preparer | Proactive tax planner | |
|---|---|---|
| When you talk | Mostly February to April | All year, with a check-in before December 31 |
| Focus | Filing last year correctly | Lowering this year’s and next year’s taxes |
| Typical questions | “Send me your documents.” | “What are you planning to buy, hire or change?” |
| Result | A correct return | A correct return and a smaller tax bill |
Most of the biggest moves for practice owners have to be in place by December 31: retirement contributions, equipment in service, owner salary, family payroll. A CPA you only meet in March can’t help with any of them.
How much does a dental CPA cost?
For an established practice, full-service tax planning, accounting and returns commonly run from about $8,000 to $18,000 a year, depending on the practice’s size, number of owners and entities, and how much bookkeeping and payroll is included.
Price alone tells you little. The better question is what you get back. A CPA who costs $15,000 and finds $35,000 in legal savings is far cheaper than one who costs $5,000 and finds nothing.
When you compare quotes, ask:
- What’s included: returns, bookkeeping, payroll, planning meetings, year-round questions?
- Is the fee flat, or will I be billed for every call and email?
- How many planning meetings do I get each year, and when?
- What did you save a practice like mine last year?
- Do you offer any guarantee on results?
Red flags when choosing a dental CPA
- They can’t name a strategy they’d use for you. A good CPA has ideas in the first meeting.
- They only talk about deadlines and documents, never about what you could change.
- Every question is billed. You’ll stop asking, and that’s when mistakes happen.
- They promise savings that sound too good to be true, or push aggressive schemes without explaining the risks.
- They don’t ask about your plans: hiring, equipment, a second location, retirement or a sale.
- They take weeks to reply. In a busy practice, slow answers cost money.
When should you switch CPAs, and how does it work?
You can switch CPAs at any time, but two windows work best:
- October to December: a new CPA still has time to plan before December 31 and can lower this year’s taxes, not just file them.
- January to early March: before your return is filed, so the new firm can review your books and catch missed deductions.
Switching is simpler than most owners expect:
- Have a first conversation. Share your last two returns and a current profit and loss statement.
- Sign an engagement letter with the new firm.
- The new firm requests your records from your previous CPA. You don’t need an awkward conversation; a short authorization is usually enough.
- Review and plan. Your new CPA checks past returns for missed opportunities and builds a plan for the year ahead.
Most practices make the switch within a few weeks, without disrupting payroll or day-to-day operations.
Not sure if your current CPA is the right fit?
Book a free 30-minute strategy session with our team. We’ll look at your last two returns and your current numbers, show you which moves your practice may be missing, and give you a rough estimate of what proactive planning could save you. If your setup is already sound, we’ll tell you.
We guarantee to find at least 2X our fee in legal tax savings for your dental practice in year one, or we refund the difference.
Frequently asked questions
What is a dental CPA?
A dental CPA is a certified public accountant who works mainly with dentists and dental practices. Beyond filing returns, they plan entity structure, owner pay, retirement plans, equipment purchases and practice transitions around how dental practices actually operate.
Is a dental CPA worth the cost?
For most practice owners, yes. A specialized CPA who plans during the year typically finds savings well above their fee through entity choice, retirement plans, equipment timing and other strategies. Ask any firm to show what it saved clients like you.
Can I switch CPAs in the middle of the year?
Yes. The new firm requests your records from your previous CPA with your authorization. Switching between October and December leaves time to lower this year’s taxes before December 31.
What should I ask a CPA before hiring them?
Ask how many dental clients they serve, whether they do proactive planning or only preparation, how and when they’ll meet with you, how they charge, and what they saved a practice like yours last year.
Does my dental practice need an S-Corp?
Not always. An S-Corp election can lower payroll taxes once profit passes roughly $100,000 a year, but it depends on your salary, state and city taxes, and number of owners. A CPA should compare both options using your real numbers.
Ready for the first call? Here are 12 questions to ask a CPA firm before you hire one.
About the author
Natalya Grigoriev, CPA is the President of Custom Accounting CPA, a Certified Tax Coach and Certified Tax Planner, and the author of two Amazon books on tax planning. Her team works with dental practice owners nationwide on proactive tax strategy, entity design, retirement plans and practice transitions. In 2025, the firm found $2,019,302 in legal tax savings for 53 clients.
