Monday, February 11, 2008

Parking Lot Dentistry

LAS VEGAS — Samantha Taube stepped out of the MGM Grand into the bright sun to walk to the parking lot. After a short distance, she approached a trailer, entered, sat in a dentist’s chair and had her teeth cleaned.

“If you know Las Vegas traffic these days, you know what a benefit this is,” said Ms. Taube, who trains employees in the huge casino’s slot machine operations. After 20 minutes, she was back at work.

Down on the Strip, Beverly Egan, a poker dealer at the Stardust Resort and Casino, sat in air-conditioned comfort, in another mobile dental office restfully decorated in pale blue amid menacing power drills and X-ray equipment. Ms. Egan had popped out to have X-rays taken before scheduled dental work. She, too, appreciated the convenience.

“I’d have to take three hours at least if I had to drive to an office,” she said. This visit took only 30 minutes.

The mobile units are courtesy of On-Site Dental, a Las Vegas company founded seven years ago by Chris Davenport, who is not a dentist but an entrepreneur. His company’s basic service combines technology, mobility and the American penchant for saving time.

On-Site Dental owns two trailers, each fitted with two dental offices in which dentists and hygienists see about 1,000 patients every Monday through Saturday in the parking lots of 11 casinos in Las Vegas. Most of the patients are employees covered by the casinos’ dental insurance plans, which pay up to 80 percent of the costs of most dentistry. Entertainment headliners and chorus line troupers, who may have the greatest need for dazzling smiles, are contract employees with their own insurance. No plans pay for cosmetic work, like veneers and tooth capping.

They are treated by eight dentists who work with On-Site, but are independent practitioners because under Nevada law a nonmedical person cannot employ them. On-Site’s management and leasing companies foot the bill for equipment and mobile units for those dental practices, and are paid rent out of the insurance reimbursements that the dentists take in — the “collect” as it’s called in the profession.

The amounts are not inconsiderable. “A fully equipped dental van can cost $450,000,” Mr. Davenport said. But with the large numbers of patients available at Las Vegas megacasinos — the MGM Grand alone has 9,000 employees — a van’s dental chairs get a lot of use.

In 2005, the total collect of On-Site’s dentists and hygienists amounted to $3 million, with Mr. Davenport’s management and leasing companies receiving almost $2 million of that. His companies cover equipment costs and salaries of 30 nonprofessional employees, who handle appointments and billing.

Mobile dentistry is not really a new idea — dental clinics working under government grants and contracts have traveled to schools and military bases for a couple of decades. Dentists on wheels got a boost in the early 1980’s when an engineer and dental equipment supplier named Tim Kitch developed a way to install the features of a dental office, from swirling water basins to oral surgery complexes, in Winnebago recreational vehicles.

“I figured they knew how to build trailers and I knew dental equipment,” said Mr. Kitch, whose company, American Dental Industries of Portland, Ore., is now manufacturing its 100th mobile dentistry.

Now, for-profit dentistry in corporate parking lots has become a growth industry in the Western states — once wide-open and now traffic-congested. And Mr. Davenport’s Las Vegas company is not the only one in the field or the largest.

ReachOut Healthcare America, is a company based in Phoenix that sends mobile dental clinics to schools and military posts in eight states. It is expanding a Dentist at Work program for corporate employees. And Onsite Dental Care, no relation to the similarly named Las Vegas company, started in 1996, catering to companies in Silicon Valley. It was started by a dentist, Dr. Arnold Keiles, who found that his patients had difficulty getting to appointments on time.

Today, the company is run by Joshua Perry, its president and an expert in medical and pension benefits, who has expanded to nine mobile units, two of them working in North Carolina and Texas, at branch sites ofCisco Systems, a major client.

“The appeal of this service for companies is that it prevents great losses of employee time, when driving and waiting in dentists’ offices can often consume half a day,” Mr. Perry said. He has had discussions about alliances with Mr. Davenport. “But,” Mr. Perry said, “we will continue to operate independently at this time.”

Mr. Davenport, meanwhile, is adding a noncasino corporate client to his company’s mix, looking to build beyond Las Vegas in the future. While his idea of mobile dentistry has caught on in Las Vegas, the entrepreneur’s road is seldom smooth.

Now 35, Mr. Davenport came to Las Vegas from Portland, Ore., in 1990, worked at a series of jobs and decided to get hygienist training back in his hometown. Then he returned to Nevada with the idea of starting his own business, using an American Dental Industries van he had financed to serve nursing homes with dentistry services.

But when “I couldn’t make enough to cover the costs on the van,” Mr. Davenport said, he hit upon two basic principles of his now successful business. First, a mobile dentistry that does not have government grants for treating schoolchildren, needs a lot of customers to make a profit. And second, the business needs, in addition to $200 fillings and $100 cleanings, some those customers who occasionally want tooth capping and veneer work at $1,000 a tooth and up.

“A good dentist can do six teeth in two hours, $6,000 for two hours of work,” Mr. Davenport said.

So to attract a potential customer base, Mr. Davenport applied to the casinos and got work initially at Prima Donna Resorts in Stateline, Nev., on the California border. Success there brought him back to Las Vegas and a contract to serveStation Casinos, which operates 14 gambling houses and 8 hotels in the city.

Mr. Davenport upgraded to two and then three mobile dental units and, seeing a need for greater expertise in finance and marketing, earned a master of business administration from theUniversity of California, Irvine, where he traveled on weekends.

But a dispute over costs with the Stations company, which self-insures its dental benefits, led On-Site to leave at the conclusion of its contract in 2005. Mr. Davenport scrambled. “I sold one van, took a second mortgage on my house, borrowed on credit lines,” he said. “And I went out and signed up to serve a lot of casinos.”

Today, On-Site Dental provides dentistry services at Caesar’s Palace, Circus Circus, Harrah’s and six other casinos in addition to MGM Grand and Stardust — and two new clients, MGM Mirage and Treasure Island. “Nobody likes to go to the dentist, but the convenience of the mobile unit makes it easier to get their dental work done,” said Jeff Ellis, chief financial officer of benefits at MGM Grand.

Mr. Davenport hopes to take dental services to casinos in other states and to nongambling customers like the Nevada Federal Credit Union in Las Vegas. “I’m in Year 2 of a three-year plan for Vegas,” Mr. Davenport said. “After that, I hope to expand beyond Nevada.”

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