The Group Dentistry Now Show: The Voice Of The DSO Industry – Episode 157

Mark Sinatra, CEO of Aspen HR and Pete Wong, CEO of Modis Dental Partners join the show to discuss the topic of human resources in the DSO and dental industry.

Mark and Pete share thoughts on:

  • HR compliance
  • Employee benefits
  • What a white glove PEO is
  • HR & benefits trends
  • Much more

To discover more about Aspen HR/s white glove PEO approach visit –

To learn more about Modis Dental Partners unique implantology and specialist partnership model visit –

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Full Transcript:
Bill Neumann: I’d like to welcome everyone to the Group Dentistry Now show. I’m Bill Neumann, and as always, we appreciate you listening in. Without a great audience like you, we wouldn’t have great guests like we have here today on the podcast. We have two CEOs here. We have Mark Sinatra, who is a seven-time Inc. 5000 list CEO, is the CEO of Aspen HR. We’re going to find out all about Aspen. They are one of the fastest growing PEOs in the country. And We also have Pete Wong, who is the Chief Executive Officer of Modus Dental Partners. They are a relatively new DSO platform that we’re going to find out why they’re different, what their growth strategy is, and find out a lot about both Pete and Mark. So first off, gentlemen, thank you both for being here, Mark and Pete. It’s great to have you on the show.

Mark Sinatra: Thank you. Appreciate it.

Bill Neumann: Thanks a lot, Bill. Let’s start with you, Mark. Could you give the audience a little bit of your bio, if you wouldn’t mind, and then a little bit of information on Aspen HR. And I mentioned that you’re a PEO. There may be some people in the audience that don’t know what that is. So you might want to fill them in on that as well.

Mark Sinatra: Yeah, absolutely. Thank you, Bill. So what a PEO is, we provide essentially a kind of a turnkey bundled HR solution for small, medium sized companies, really across the key areas of HR, including payroll processing, HR technology, employee benefits, and HR compliance. So PEO stands for Professional Employer Organization. So You know, we’ve got some larger competitors that are fairly well known, such as ADP and Paycheck. So we kind of compete in the same space. So I’ve been in the PEO industry for 15 plus years now, been with Aspen for three and a half years and appreciate the intro earlier. You know, like you said, you know, we’re definitely on a fast growth trajectory, you know, and one of the industries that we’ve kind of focused on that has helped us with our growth is really, you know, being a value add HR partner to both private equity funds and their portfolio companies, and also from an industry perspective, really honing in on the DSO space and being a value-added HR partner to growing dental organizations, which we’ll get into a little bit today.

Bill Neumann: Excellent. Thank you, Mark. And again, the other CEO we have on today is Pete Wong, Modus Dental Partners. Pete has really interesting background. He was, before he joined Modus, he was Chief Sales Officer on the vet side of things, National Veterinary Associates. And he also has a background in US Army Special Operations. So Pete, a little bit about your background, if you wouldn’t mind, and then The audience would be really curious to find out about Modus Dental Partners, relatively new platform. So could you discuss yourself and a little bit about the company you’re with?

Pete Wong: Yeah, sure, Bill. Thanks a lot. Thanks for the warm, warm intro. As you mentioned, I started my career as an officer in the US Army, graduated from West Point, branched infantry, spent five years in the Army, the last three of which were with the 75th Ranger Regiment, US Army Special Operations Unit. After deploying four times, twice to Iraq, twice to Afghanistan, really just got to a point in my life where I had to make a decision for the type of husband and father I wanted to be and decided to move out of the military. I transitioned into the business world first by going to business school and then working in a variety of both finance operations and business development roles. started as an investment banker in London, moved back to the U.S., working in manufacturing operations, ultimately running a handful of manufacturing plants, and then was blessed enough to have the opportunity to move into multi-site healthcare, beginning on the veterinary side. I started in operations with National Veterinary Associates, led their Northeast division, and transitioned into business development where I ultimately took a leadership role. In September of 2022, I had the opportunity to partner with the Thurston Group where we founded MODIS Dental Partners. MODIS stands for Modern Implantology and Specialty Dental Partners. We did this in partnership with Dr. Picos, Dr. Picos has six multi-specialty dental practices in the Tampa area. and has an institute, the Picos Institute, which has been in existence for over three decades, has trained 6,500 dentists, both specialists and general practitioners. And MODIS’s growth strategy has always been a partnership model. And we are focused on growth-oriented, primarily general practitioners, that are passionate about patient care and implantology. And our belief was, and as we looked across the dental profession, what we observed was, one, implantology has been growing at a rate disproportionate to the profession at large. Two, due to the growth of technology, more and more general practitioners are placing implants. And thirdly, this came as a bit of a surprise to me, But implantology isn’t widely taught in dental school. And as a result, there was a real need for advanced continuing education. And that was what attracted us to the partnership with Dr. Picos. He has for three decades, not only been teaching specialists, but also general practitioners on the placement of implants and is world renowned. And so we really believe that we’re poised to not only grow and attract general practitioners that are passionate about implantology, but really positively impact the profession by arming each and every one of our partners with the very best training available.

Bill Neumann: That seems like a great partnership and PECOS has a world-renowned name. There’s a huge need in the industry for clinicians getting more clinical education and at the same time looking for business support. Don’t want to deal with things like HR. Mark’s going to talk about that in a second. But yeah, it seems like a great marriage of that clinical education that is really needed out there, that mentorship opportunity, and also the ability to really focus on what you went to dental school for, dentistry, instead of running the business. Well, that’s great. And it was late September of last year, right? So relatively new. MODIS is relatively new.

Pete Wong: That’s right. We actually formed our partnership or finalized our partnership with Dr. Pithos in April of 23. And since then, we have had three additional partners join the MODIS platform.

Bill Neumann: Well, that’s great. That actually leads into the next question, which is really your growth strategy. And you discussed a little bit how MODIS Dental Partners differentiates itself from others in the DSO space. I don’t have to tell either one of you this, there are a lot of different models out there. There are a lot of opportunities for dentists looking for partnerships. So talk a little bit about the differentiation and then your growth strategy, Pete, if you don’t mind.

Pete Wong: Yeah, sure. As you said, the DSO space, you have many options as a dentist thinking about partnership. And for us, we’re absolutely committed to every one of our dentists being equity partners. And we’re also very open to the possibility of site level joint ventures as well. For us, it is key that anyone joining the platform is aligned with a mindset of continuing education and growth. And when you think about DSOs, I think table stakes are being able to support the back office, take away some of the administrative aspects of business ownership. And then you think about, if that’s the defensive side, what is the offensive side and what is our special or secret sauce? And what we believe is, With any platform, you have to have some angle toward organic growth. And for us, it’s a belief that if we partner with doctors that are committed to growing through implantology, that Access to the PCOS Institute is the premier way of training and growing that skill set, as proven and evidenced through three decades of training. Most recently, Dr. Picos has launched a continuum for the fundamentals of implantology. So just by way of background, Dr. Picos is a world-renowned oral surgeon, has, as I said, a multi-specialty practice, and his institute has always been taught by himself and other dental specialists across periodontist, prosthodontist, and himself as an oral surgeon. Historically, Dr. Picos has really played in the area of what I would consider the advanced level implantology placement, zygomatics, etc. what he is now doing is also launching a continuum for the fundamentals. And what that allows us to do as a platform is meet any partner along their implant journey and provide them access to advanced continuing education that would elevate their skillset. So that’s number one. Number two is, And Dr. Picos will say the same. There are many doctors that attend his courses, learn the skills and the tools to place implants, and they go back to the practice, and they never place an implant. They place an implant And then they never place another. And, and much of that comes down to confidence. It comes down to having access to a community of practitioners where if they run into a complication they have easy access to experts in the field. As we grow our platform, we continue to accumulate more and more experts and really fostering a community that is supportive of any one of our partners attempting to grow into implantology or continue to grow in their journey of implantology.

Bill Neumann: So while we’re still focused on your growth strategy and we have Mark with us, talk a little bit about how you and Aspen HR found each other and why you’ve partnered with Aspen HR and how they’re assisting Modus Dental partners with your growth.

Pete Wong: Yeah, sure. I’d love to touch on that. Mark and I go way back. probably about 25 plus years back, actually.

Mark Sinatra: Crazy to think about how long it is.

Pete Wong: Yeah, Mark’s younger brother, Joe, and I were best friends growing up from elementary school actually through high school and continue to be very good friends. And as I entered into my role, I just happened to be catching up with his brother, Joe. And he mentioned, hey, you should speak to Mark if you’re considering a PEO. At this point, I had already initiated a search. I was working with three other PEOs, one of which was one of the large players and two boutique PEOs. And I started a conversation off with Mark. And I told him, I am looking for a true partner, a strategic partner, an on-the-ground partner. I’m all ears, but candidly, I’ve already started down this process, and also to be very clear, one of those groups was in pole position because other Thurston portfolio companies had already used this PEO. what differentiated Aspen HR from everyone else is all around their assessment of our healthcare benefits. And to be clear, of the four, three had the same recommendation. The three had stated, stay with the current plan that you’re on and come July, you ought to either renew or at that point, we can go out to market and find another health plan. Aspen came back with a very different recommendation. They said, look, we have run our analysis. What we can tell is there is an above average chance that if you wait until the renewal period, you’re going to face a large increase, price increase, And unfortunately, that large price increase is what we’re going to have to take to market to then look for other plans. So you’re starting off with a higher benchmark pricing. And so what we recommend is you transition over to this plan. We’ve mapped or I should say mirrored the plan that you currently have so that your team faces no disruption. We can lock this plan in for 12 months. As you grow, your pricing power will increase. And in that 12-month period, when we go to renew, we can almost guarantee that you’ll have lower pricing going forward. And sure, as the sun rises, that is exactly how it’s played out. We’re coming to open enrollment in June, and we’re going to see some favorability based on our growth. It was a key differentiator for me that this was a group, a team that was going to go above and beyond. That continues to be reinforced with our partnership. We are a buy and build business. M&A is a big part of what we do. Every week, I have a deal execution call, a member of Mark’s team, two members of Mark’s team actually are on that call weekly. They’re providing us with insight on all things human capital related to include benefits, but also they’ll take a deep look at, do we have any risk associated with the the profile of comp structures of the team we’re looking at? Are they paying below market and that’s a risk for us? Is this an in-market type of team? So they’ve been a wonderful partner from start through present day.

Bill Neumann: Thanks for that, Pete. Mark, this really leads into some feedback from you. Well, first off, it sounds like you’re Your partnership with MODIS was a lot different or your approach with MODIS was a lot different than some of the other PEOs. Can you explain why maybe you had the You did the work to say, hey, you can make changes now and lock in rates, which would be more beneficial. Why did some of these other PEOs or all of the other ones that Pete had talked to pretty much say, just stick with what you have? Why would they say that? I’m curious.

Mark Sinatra: Well, I, you know, Pete was doing such a good job, I thought I wouldn’t, you know, have to really say anything, you know, for the next 30 minutes, but it was so good. So thank you. Thank you, Pete. It’s a good question. But I mean, I think, you know, ultimately, and it’s not I’m not meaning this to come off a negative way at all. But it’s really two things. First, we’re business people, right? So like we, we look at how HR can positively impact and create value from a strategic perspective, first and foremost. So it’s kind of the opposite of what I would call being solely transactional, where, you know, when we talk to a prospective client, it’s not about, you know, getting that sale at all. It’s really about let’s first understand the strategy. What are you trying to achieve? in the short term and long term, and then let’s craft a solution that meets those goals. I don’t mean it to sound overly simplistic, but really at a high level, that’s really what it is. I think when it comes to the buy and build strategy that Pete and his team have really effectively executed on in a fairly short amount of time, you’re talking about Pete, I think you said like three add-ons in about a year. And, you know, I think there’s a pretty robust pipeline going forward. So, I mean, that’s a lot of activity. So, you know, as the HR and benefits and payroll provider, we’ve got to understand, given that strategy for these acquisitions, you know, what’s roughly going to be the headcount? How is that going to change the kind of the risk factors and the demographics that could impact, you know, the employee benefit strategy. You know, what parts of the country, you know, what, you know, kind of aligned with the, you know, the networks for the medical carriers. how are these deals typically going to be structured? Stock asset purchase, are the EINs going to be absorbed or are they going to stay the same for some period of time? Those are all the things that we know kind of what to ask and look for because we have solely focused, and I failed to mention this in the intro, solely focused on serving the needs of private equity funds and their portfolio companies since we started six and a half years ago. Because we’re a vertically focused service provider, it has enabled us to have that you know, edge or, or, or really kind of, I would say domain expertise when it comes to providing our services, particularly for this industry. And I’ll say the opposite too. Like, you know, if, if we’re talking to, I don’t know, like an organization, I’ll just throw a random one out like a window washing company. Right. I mean, you know, that’s not an industry we specialize in going to quite honestly. So, you know, we may not be the best provider, but we do think, You know, we certainly are, you know, the best provider for, you know, private equity funds and particularly ones that are in what I would call the healthcare space that have a distributed model, multiple locations, multiple sites, multiple states growing quickly, organically, and through add-ons. We do think we’re the best provider because, you know, we’ve proven that time and time again with some of our clients. So.

Bill Neumann: And I know on your website, you really, you talk a lot about being a white glove PEO, and you’ve customized your service model to really meet the needs of DSOs. So you touched on that a little bit with your expertise, working with private equity backed healthcare platforms, multi-site. Can you talk a little bit about some of the customization that you do specifically to DSOs?

Mark Sinatra: Yeah, I think, thank you. Um, I think, you know, when, when you look at, you know, the DSO model, obviously, it’s, it’s, you know, it’s, you know, by nature, it’s, it’s clinic based, it’s in person. And, you know, there’s, there’s a personal element to it, where, when, you know, we, we take on a new DSO client, whether that’s as a standalone, or whether that’s part of you know, an add-on acquisition strategy that Pete and his team are executing on, you know, we are treating that with the highest level of care because we understand that the folks that really make the magic happen is, I mean, it’s everybody in that practice, right? Whether they are, you know, patient facing in person or maybe on the phone. And so we need to make sure everybody’s feeling good, right, about the transition, about their new benefit plan. They have a clear understanding of how payroll is going to work. And, you know, most importantly, you know, when they have a, you know, question or concern, they know who to contact from our team for what kind of question. And that, you know, we have a rapid response model where, you know, we look at our SLAs, which, you know, are much more aggressive from a time to response perspective than I think, you know, most of our peers. So, you know, we ensure that, you know, part of the White Glove experience is that our clients are, you know, getting a response on a very timely basis, particularly when it comes to, you know, when they’re in the implementation phase. So, you know, going back one last thing to your question, you know, when there is a new group that comes on, because it’s clinic and site-based, we will frequently go on site and actually take the employees through, like I said, all of these things that I mentioned before. And we do that on site in person. And I think from what I’ve seen in the last three or four years, through the pandemic and the aftermath and whatnot, You know, certainly, you know, we’ve, we’ve, I think all benefited from the proliferation of leveraging zoom teams, et cetera, for, you know, business related communication. But I feel like on the other side of the coin, like kind of the lost art is really building that face to face relationship. And I think that is unfortunately kind of gone by, by the wayside. Um, but. we strike, I think, a very kind of, I would say, nimble balance between the two. And, you know, we have not forgotten about the importance of having that in-person communication, particularly when it comes to a practice that, you know, is entering into a new partnership or acquisition, because, you know, again, very, very, very important to treat that with the utmost level of care and concern.

Pete Wong: Yeah, I might add some finer points, Steven, to what Mark has mentioned about the white glove service. Bill, I’m sure this would resonate with you and all of your listeners that in any transition, it’s not just the provider, but it is the entire team that is critical to the success of the practice. And second to compensation benefits are critical, and being able to provide comparable benefits is critical, and being able to communicate that in detail is critical. Modus, our stance is we want to be a partner friendly business. And a big part of that is making sure that the team members are well cared for, particularly through a transition. And as Mark mentioned, in every one of our integrations, so Right now, we have with Dr Pico six sites plus the Institute plus three additional sites. One of the sites had 76 has 76 team members so it’s a large dental practice in every instance. A member of his team has come on site with MODIS as a MODIS team member, effectively, and presented benefits. And not just a canned presentation of these are your benefits. There was a tremendous amount of homework that went in and preparation that went into those meetings. And to be specific, line by line, every single team member, what their current benefits are, what the cost is, what the employer contribution is, what the new plan looks like, If we would need to gross up income in order to keep the team members economically whole, every single person was accounted for. And when we meet with the team, we stay the entire day and we meet with every individual so that each and every person can feel very comfortable and confident that the team is going to be cared for. And it makes all the difference in a transition. Bill, as you know, and all of your listeners know, failing at integrations is the absolute worst way to get started in a partnership. And so the work that Mark’s team does is critical to a smooth and easy transition for practices during what is a very tumultuous time.

Bill Neumann: Yeah, that is a great point, Pete, about integration and some of the challenges that you might, it’s probably not unlike an interview with a prospective employee. The group may look good on paper and may be an ideal cultural fit, but that integration process is key to making that work. just like onboarding an individual.

Pete Wong: Yeah. You know, it’s one thing to stand in front of a group of people and talk about core values and the importance of culture. But if you’ve, if you missed the detail about how their benefits are going to play out, it’s all lip service. And so to be able to introduce ourselves during a welcome meeting and have a partner like Aspen with us, and then be able to talk to each individual and show them that we’ve done the work. When we say that we intend to provide them comparable or better benefits, it’s not lip service. Every single person has been thought of on an individual level. and accounted for on an individual level. And us being able to not only make that representation, but then back it up on the very day that we meet, it goes a long way with putting a team at ease. Because as you know, no integration ever goes perfect. So being able to win the goodwill and show what our intention is on the front end during that first meeting is critical to setting ourself up for a successful partnership.

Bill Neumann: Pete, we talked a lot about the growth of MODIS dental partners. When you take a look at the next two to four years at a macro level, what does the DSO space look like? What are the opportunities look like from your perspective for MODIS?

Pete Wong: Sure, I think it’s safe to say that this space is still relatively fragmented and there are many opportunities for DSOs to make a positive impact on the profession. And I also would be remiss if I didn’t state the obvious that in the next year with our current interest rate environment, there is more and more focus on delivering operational excellence. Or I think many of the people you’ve spoken with have mentioned organic growth in one way, shape or form. For us, I see the opportunity that MODIS brings, particularly as an opportunity in this time and space where organic growth is so critical, because the question really becomes, how do you grow? And in my mind, there is a path to growth that advances the profession in a positive way, and a path to growth that may not advance the profession in a positive way. And for us, being able to elevate the care of patients through implantology education, advanced continuing education in implantology is a real opportunity for us to drive organic growth in a positive manner that in the future we’ll be able to look back on proudly and see how MODIS in our partnership with our founding doctor, Dr. Picos has been able to move and advance the profession. Relatedly, In order to grow the practice, you have to have the skill to organically grow the practice, whether that is operational efficiency, focus on expansion of the physical plant of a practice. And among our partners, every single one of them has a growth plan in place. It’s something that we talk about actually prior to ever consummating a partnership. just to make sure that we’re aligned from a cultural perspective, that I think it’s helpful to have a conversation about the future. In the next two to four years, It stands to reason that the market will continue to open back up. Right now, we seem to be in a little bit of a slow spot with valuations, not only at the portfolio level, but also at the practice level. And this is largely driven by interest rate pressure. But in the next two to four years, the market tends to be cyclical and likely will be on an upswing at some point during that time. And we’ll see more and more transactions happening across the space. But for us at MODIS, we’re just very focused on executing on our plan, finding great partners, focused on growing, specifically in implantology, that are culturally aligned with us, and helping each of them as individuals grow and achieve their dreams for their practice and their team members and patients.

Bill Neumann: Thank you, Pete, for the insight regarding the DSO space. I think you’re right on with what we’re seeing right now and the trends, the slowdown that we’ve seen in the past year, the focus on same-store organic growth. Easier said than done. You can say the word, but how do you do it? There are a lot of different ways to do that. I think a lot of it is how can we do it clinically, and that becomes one of the biggest challenges. And if you don’t have the skill set, where do you get that from? So I think MODIS is really positioned well to offer that clinical excellence, specifically on the implant side. So, Mark, this one’s for you. This is more wrapped around HR and benefit trends that you see. So what should people in our audience, those emerging dental groups, the DSOs that are listening, what should they be watching out for? What do you see on your radar?

Mark Sinatra: Yeah, I think a couple of things jump out. You know, one thing on the HR end that’s actually has been announced and, you know, supposed to go into effect actually later this month of March is some revised guidance on how employers classify workers. So, you know, when an employer has a worker, they’re in almost, you know, all cases a W-2 employee, but in some cases, you can justify that worker to be classified as a 1099 contractor. And there’s been some revised guidance out there that, like I said, that’s going to go into effect later this month that is going to make it harder and more stringent criteria for an employer to classify that worker as a 1099 contractor. So, you know, what we’re recommending to our clients across many industries, but particularly in the DSO space, is to, you know, later this month in March and April, just, you know, do a refresh and review of, you know, all your workers, particularly your 1099s, if you do have any 1099s, and to ensure that they’re classified appropriately. And if they’re not, then you need to figure out a way to convert them to W-2 so that it doesn’t impact the business and understand financially what that kind of equivalent wage would be from converting somebody from a 1099 to W-2 salary. So that is one thing that’s kind of pressing, that’s on the horizon as it relates to HR compliance. Another thing on the employee benefits side, and this one, unfortunately, it’s just been going on for several years, and it’s unfortunate, but the rising costs, the escalating costs of medical insurance continues to be a pressing issue, particularly for our healthcare clients. you know, what we’re seeing in, in, you know, I would say the, the open market for, you know, renewals, not, not on necessarily on Aspen’s plan, but just in overall, in terms of industry benchmarking, we’re seeing companies, you know, get renewals of, you know, high single digits and some cases even low, low double digits. I know with, with Aspen’s, with our partnership with, With Aetna, we’ve been able to achieve very stable renewals of 4%, really since inception. But the broader market has continued to deal with larger increases year over year on medical insurance that has made it really tough for that employee to continue to afford. Because if you look at wage growth, And you overlay that with the cost of medical insurance increasing. The medical insurance is increasing at a far faster rate than what we’ve seen annual wage growth. So it’s becoming a bigger issue for employees and employers. And there’s a couple of solutions out there. There’s a lot of options, like I said, nowadays to potentially reduce medical costs. I know oftentimes when we see a practice that has, you know, a medical policy that, like I said, is in the open, quote unquote, open market, you know, through the state exchange, in almost all cases, you know, we’re able to save that practice thousands and thousands of dollars, you know, through our large group medical plan with Aetna. So that certainly could be a solution. There’s other solutions out there as well. And particularly if you’re of certain size and scale, you know, 50 or I would say at least, you know, 50 to 100 employees. Sometimes, you know, going to some sort of partially self-funded or self-funded route could be an option as well. But, you know, there has to be a lot of analysis done to ensure that that’s going to be the right solution for you. So that is kind of the silver lining is that we’ve seen more options to reduce medical costs nowadays than I think what existed several years ago, but it still continues to be a challenge, particularly like for smaller practices that have, you know, 10 employees, 15 employees, it can be very cost prohibitive at times to provide, you know, high quality benefits program. So those are the two things that, you know, we’re continuing to see on the horizon here from an HR benefits perspective.

Bill Neumann: Well, that’s some great insights, Mark. Mark, if anyone in the audience wants to find out more about Aspen HR, or if they want to contact you, how do they do so?

Mark Sinatra: Yeah, thank you. Yeah, definitely check us out on on the website to learn more Feel free to send me personally an email as well. It’s Mark with a K at And we’ll, you know, we’d love to talk to you and learn more about your practice.

Bill Neumann: Great. Thank you, Mark. Pete, if anybody wants to find out about a potential partnership with Modus Dental partners, or they just want to reach out to you, Pete, how would they do so?

Pete Wong: Yeah, easiest way to reach out to me, email at Pete at And if they want to learn more about Modus Dental, you can check us out on our webpage,

Bill Neumann: Great. And we’ll make sure we drop those URLs in the show notes, as well as those email addresses. Thank you, Mark Sinatra, CEO of Aspen HR, and Pete Wong, CEO of Modus Dental Partners, for being on the Group Dentistry Now show today. Appreciate it. Some really great conversation. Got to learn a lot about a relatively new platform out there, Modus Dental Partners. partnership with PECOS and also all about HR and PEO. And really, I love the white glove service that you provide, that customization. I think that’s something that we really don’t see much of today. And I think in particular, with all these DSOs and their models being so vastly different, that that’s critical to any type of partnership with a PEO in the dental industry. So thanks again, Mark. Thanks, Pete, for being on the show. We appreciate it. And until next time, I am Bill Neumann, and this is the Group Dentistry Now Show.

Mark Sinatra: Thank you. Thank you.