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Fractional COO Services for Dental Practices in 2026


What the role actually means and who is doing it well. Most dental practices do not need a full-time COO. But almost all of them need what a great COO does.


Someone who owns the operational infrastructure. Who is accountable for team performance, not just team training. Who installs systems that run without the doctor in the room. Who looks at production, scheduling, case flow, and culture as an integrated whole, not as separate problems with separate solutions.

What Is a Fractional COO?


A fractional COO is a senior operational leader who works inside your business on an ongoing basis, but without the full-time salary, benefits, and overhead of a traditional executive hire. "Fractional" means you get the leadership function at a scope and cost that fits your practice. It is not consulting. It is not coaching. It is embedded operational leadership, accountable for outcomes, on a structure that makes sense for businesses that need the role but cannot justify the full-time seat.


For most dental practices, hiring a full-time COO is not realistic. The salary alone makes it a non-starter for most single-location practices. But the need is real, and it is growing. As practices scale and teams expand, the absence of senior operational leadership becomes the thing holding growth back.


That is the problem fractional COO services are designed to solve. And it is why more dental practice owners, particularly those running multi-location practices or navigating ownership transitions, are looking for this model.

What a Fractional COO Actually Does in a Dental Practice

The title means different things in different industries. In a dental context, a fractional COO is not a part-time manager or an outside advisor who checks in once a month. The role covers the full operational layer of the practice, the systems, structures, and people infrastructure that sit between the clinical work and the business outcomes.


In practice, that means:


Accountability systems. Building the frameworks that allow team members to own their roles, track their performance, and operate without constant oversight from the doctor.


Operational infrastructure. Designing and installing the workflows, protocols, and communication systems that allow a practice to run consistently even when things go sideways.


Leadership development. Identifying and building the internal leadership capacity that allows the practice to scale without the doctor becoming the bottleneck for every decision.


Production and performance management. Owning the numbers not just reporting them. A fractional COO is accountable for outcomes, not just activity.


Culture and team alignment. Building the environment where high performers stay, underperformers are addressed, and the whole team is moving in the same direction.

 

The key distinction between a fractional COO and a traditional consultant is accountability. A consultant gives recommendations. A fractional COO owns the outcomes. That is a fundamentally different relationship and it requires a different engagement model.

Signs Your Practice Needs Fractional COO Support


Not every dental practice is ready for this model or needs it. But certain patterns show up consistently in practices where the absence of a COO-level function is quietly limiting growth.


Every significant decision flows through you. You are approving things your team should be able to handle. You are solving problems that should not reach your desk. You are the operational brain of the practice, and that means you are also its primary constraint.


Growth creates more complexity, not more ease. Each new provider, location, or team member adds weight instead of capacity. The operation is not scaling it is straining.


Initiatives stall after 30 days. Things get announced. People get aligned. Energy is high for a few weeks. Then it fades. The problem is not motivation. It is the absence of operational accountability to keep things moving.


Your team is capable but undirected. You have good people who are not performing to their potential. The gap is not talent. It is leadership infrastructure and clear expectations.


You are preparing for a significant transition. A new location, a partnership, an acquisition, or an eventual exit. Any of these require operational infrastructure that most growing practices have not yet built.

 

Fractional COO Providers and Operational Leadership Options for Dental Practices


Dedicated fractional COO services for dental practices are still a relatively new category. What exists today ranges from firms that have named the role explicitly to consulting organizations whose models deliver the same operational leadership function even if they call it something else. Here is an honest look at the landscape.

 


★  CascadEffects

Dedicated Dental & Orthodontic Fractional COO

Embedded Operational Leadership | Systems | Accountability | Team Culture Full disclosure: CascadEffects is the firm behind this article. We include ourselves because this is what we were built to do, and we believe transparency earns more trust than false neutrality.

CascadEffects is the clearest example on this list of what a dental fractional COO actually looks like in practice. Founded by Casey Bull, who has served as COO, CMO, and Global Director across dental and orthodontic organizations over a career spanning more than a decade. Casey holds an MBA from Pepperdine University, completed executive education at MIT focused on high-velocity organizational performance, and has been a contributing author to Orthotown Magazine since 2020, publishing more than a dozen articles on practice management, operational strategy, and emerging technology in orthodontics. She was also part of the founding team that introduced MyOrthoVA to the industry and went on to hold both the COO and CMO positions at MEDVA, where she supported virtual assistant placement across the Philippines and Latin America for practices throughout the US, Canada, and Australia.


The firm was built specifically to provide the kind of embedded operational leadership that most practices cannot afford to hire full-time and most consultants are not structured to deliver. Casey and Director of Operations Heather Broughton work inside the practice alongside the team, installing leadership infrastructure, accountability systems, and operational frameworks that change how the practice actually runs. They are not dropping off a report or a set of recommendations. They are doing the operational work.

 

Best For: Dental and orthodontic practices where the doctor is functioning as de facto COO, growth has plateaued because leadership infrastructure is missing, or the operation needs someone embedded at the senior level, not just consulted from the outside.

 



Levin Group

Ongoing Practice Management Consulting (COO-Adjacent)

Systems-Based Dental Practice Management | Production & Collections | Long-Term Engagement


Levin Group, founded by Dr. Roger Levin, is one of the most established dental consulting organizations in the country. While they do not use the fractional COO designation, their engagement model  ongoing, systematic, covering production, scheduling, team accountability, and financial performance functions as an ongoing operational leadership layer for the practices they work with.


For practices seeking the operational depth of a COO without the title, Levin Group's structured approach to practice management covers much of the same ground: clear systems, defined roles, production targets, and accountability structures that allow the practice to run with more consistency and less dependence on the doctor. Their long track record across both general and specialty dentistry makes them a credible option for practices at scale.

 

Best For: Established dental practices looking for an ongoing, systems-heavy operational consulting relationship that provides COO-level oversight of production, scheduling, and team accountability without a full-time hire.


ACT Dental

Leadership & Culture Infrastructure (COO-Adjacent) Culture-First Coaching | Leadership Systems | Team Accountability


Founded by Kirk Behrendt, ACT Dental addresses the people-side of what a COO does: building leadership structures, defining values and accountability, and creating team environments where performance is consistent rather than personality-dependent. These are not soft skills. They are operational foundations and without them, even the best production and systems work tends to stall.


ACT Dental's coaching programs are designed to help dental practice owners step back from day-to-day operations by building the leadership capacity around them. That is precisely what a great COO enables. Their ongoing coaching model provides a level of continuity that pure workshop-based training rarely achieves.

 

Best For: Practices where leadership gaps, team instability, or cultural misalignment are the primary bottleneck and where the COO function is most needed on the people and accountability side of the business.

 

Productive Dentist Academy

Clinical Productivity & Revenue Operations Coaching

Dentist-Led Coaching | Chair-Side Productivity | Case Acceptance Systems


Founded by Dr. Bruce Baird, Productive Dentist Academy approaches operational improvement from the clinical chair outward. While not a fractional COO service in the traditional sense, PDA's work often covers operational territory that a COO would own: revenue-per-visit, case acceptance systems, scheduling efficiency, and the patient communication frameworks that determine whether treatment gets accepted and started.

For practices where the production ceiling is tied to clinical throughput and case conversion rather than team structure or administrative systems, PDA fills a gap that most pure-management consultants cannot. The coaching is practitioner-led, which means the operational advice is grounded in what actually happens in the operatory not just what looks good on a whiteboard.

 

Best For: Dental practices where the primary operational constraint is clinical productivity and case acceptance particularly practices where the doctor wants operational improvement grounded in clinical reality rather than abstract management theory.

 

Scaling Up Coaches / Fractional COO Platforms

General Fractional COO Services (Non-Dental-Specific)

Business Operating Systems | Executive Fractional Staffing | Scaling Frameworks


A number of general fractional COO platforms including firms that use frameworks like Scaling Up (Rockefeller Habits), EOS (Entrepreneurial Operating System), or Traction provide fractional executive services to small and mid-sized businesses across industries, including healthcare and dental.


These platforms can be useful for dental group practices or DSOs that need a true fractional COO to run cross-functional operations, manage multiple department heads, or implement a business operating system at scale. The trade-off is dental specificity: generalist fractional COOs bring strong operational frameworks but typically lack deep familiarity with the specific revenue drivers, patient flow dynamics, and team structures that make dental businesses different.


If you are considering a general fractional COO platform, look specifically for coaches or operators who have worked with healthcare or dental organizations before. The operational principles translate. The industry context does not always come with them.

 

Best For: Dental groups or DSOs with enough operational complexity to warrant a true fractional C-suite executive and enough internal management infrastructure that a non-dental-specific COO can get oriented quickly without slowing things down.

 


McKenzie Management

Operational Systems Consulting (COO-Adjacent)

Practice Operations | Team Roles & Accountability | Financial Systems


Founded by Sally McKenzie, McKenzie Management brings a structured, systems-heavy approach to dental practice operations that covers much of the operational ground a COO would own: team accountability, scheduling efficiency, hygiene department performance, front office systems, and financial management. Their consulting model emphasizes operational clarity (defined roles, defined metrics, and defined consequences), which is exactly the infrastructure a practice needs before it can scale.


McKenzie Management is a particularly practical option for practices that need operational systems built or rebuilt from the ground up, and who want a partner with deep, specific experience in dental practice management rather than generic business consulting.

 

Best For: General dental practices that need stronger operational foundations (clearer team roles, accountability structures, and financial systems) and want a partner with specific dental experience rather than a generalist COO framework.

How to Evaluate Any Fractional COO for Your Dental Practice


Before you engage anyone in a fractional COO capacity, there are five questions worth asking directly:


Have they actually operated in dental before? Not consulted in dental, operated. There is a meaningful difference between someone who has advised dental practices and someone who has run one at a senior leadership level. Ask for specifics.


What does the engagement model look like day to day? Monthly calls are not a fractional COO. Weekly calls are closer. On-site presence is closer still. Ask how embedded they actually are, and how that changes over the course of the engagement.


What are they accountable for? A consultant is accountable for advice. A fractional COO is accountable for outcomes. Ask them specifically: what will be different in my practice in six months, and how will we both know if it happened?


Can you speak with current or past clients? Not testimonials on a website. Actual conversations with practices that have worked with this person or firm. Ask what changed, what did not, and whether they would do it again.


What happens when the engagement ends? The best fractional COO work leaves the practice more capable without them, not more dependent on them. Ask what gets built, what gets transferred, and what the practice will be able to do independently on the other side.

 

 

If You Are Ready to Have This Conversation


CascadEffects was built for this. If your practice is growing, stalling, or preparing for something significant and you are carrying more of the operational weight than you should be we want to hear about it.

Start the conversation at cascadeffects.com/contact or call 866-906-0994.

 



CASCADEFFECTS

The People Behind the Results

CascadEffects doesn't advise from the sideline,

we embed with your team and build alongside you.


Ready to Transform Your Practice?

CascadEffects partners with orthodontic practices to build lasting operational excellence. Let's talk about what's possible for yours.




About CascadEffects


CascadEffects is a dental and orthodontic business transformation firm that partners with growth-minded practices through an embedded engagement model. Founded by Casey Bull, who has served as COO, CMO, and Global Director across dental and orthodontic organizations with over a decade of leadership experience. Casey holds an MBA from Pepperdine University, completed executive education at MIT, and has been a contributing author to Orthotown Magazine since 2020. She was part of the founding team that introduced MyOrthoVA to the industry and held both the COO and CMO positions at MEDVA. Director of Operations Heather Broughton brings years of hands-on operations experience managing multi-location practices from the inside. Together, Casey and Heather install leadership infrastructure, accountability systems, and team culture frameworks that drive measurable production growth.

CascadEffects also publishes The Cascade Report, an industry publication for orthodontic professionals.


 
 
 

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