The Dentalpreneur Podcast w/ Dr. Mark Costes 2448: How to Run a 50-Person Dental Powerhouse
Feb 18, 2026
Ashley Keith, COO of Keith & Associates Dentistry, leads operations and team development at a 50+ person, highly systemized dental practice. She describes scaling from 13 to 23 operatories, hiring for personality over resume, building digital SOPs and training libraries, running weekly clinical calibration meetings, and creating leadership captains and consistent systems to preserve culture and quality during rapid growth.
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From Cerner Onboarding To Dental COO
- Ashley moved from Cerner HR and marketing to run operations at her husband Bill's dental practice after he bought it and needed business help.
- They planned growth together, expanded from 13 to 23 operatories, and she transitioned from temporary helper to full-time COO while scaling the team to ~50 staff.
Growth Reveals Hidden Processes
- Rapid physical growth breaks implicit knowledge because people who 'always did it' are no longer proximate to others.
- Ashley describes undoing a 'ball of yarn' by writing down tasks and processes once teams were spread across floors.
Hire For Personality Over Resume
- Hire for personality and culture fit first, then train clinical or technical skills.
- Ashley prioritizes outgoing, patient-focused hygienists and admins, then teaches office-specific perio protocols and implant conversations.