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Office Visit: Dr. Hideki Ikeda by Kyle Patton, associate editor

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Office Visit: Dr. Hideki Ikeda 

This doc’s exceptional career is a masterclass in expansion, management and partnership

by Kyle Patton, associate editor
photography by Christina Gandolfo

Orthodontists spend most of their working hours inside their own practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Orthotown’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of how they practice.
Few Townies have achieved a level of success like Dr. Hideki Ikeda . From a humble and relatable start—taking over a practice from a retiring doc—Ikeda would slowly begin to modernize and expand his solo practice. Soon enough, though, expansion became the name of the game. Having support systems in place made opening new offices manageable, Ikeda explains. “We didn’t need to reinvent the wheel each time.”

In our exclusive Q&A, we visit one of Ikeda’s seven practices and hear his process, advice and the story of a remarkable career that has, so far, spawned more than half a dozen orthodontic/pediatric dentistry partnership practices in the heart of Southern California. Learn how he manages and trains more than 150 employees, what to focus on when beginning a growth or partnership plan, and plenty more.
OFFICE HIGHLIGHTS
NAME:
Dr. Hideki Ikeda

GRADUATED FROM:
Baylor College of Dentistry (now Texas A&M University School of Dentistry)

PRACTICE NAME:
Sweet Smiles Modern Orthodontics
7 Southern California locations

TEAM SIZE:
150+
How’d you find your way into orthodontics?
In all honesty, my interest in orthodontics wasn’t driven by some lifelong dream, but by the sheer challenge of breaking into such a competitive field.

My journey to dental school marked a second career for me. I had earned a degree in biology during my college years, but found myself drawn to the IT world because of the tech boom reshaping our lives at the time. Embracing cutting-edge technology was undeniably thrilling, but the crash of the internet and the inherent instability of the IT field prompted me to reevaluate my career path and redirect my focus back to health care. Starting dental school at 29 felt like a fresh start for both my personal and professional lives. I made a promise to myself to dive into as many opportunities as I could, aiming to grow both personally and professionally.

Inspired by this new outlook, I took on leadership roles like class president and joined the ethics committee. I also got heavily involved in research and even became ASB president. All this hands-on experience helped me see that specializing in orthodontics— something that had once seemed out of reach—was a goal I could achieve.

At that time, I had limited knowledge about orthodontics, having never undergone orthodontic treatment myself. My perception changed when I discovered that the University of Southern California School of Dentistry offered an orthodontic program in which interested students could work with orthodontic patients and gain insight into the field. During this program, I was exposed to the world of orthodontics, and with the support and guidance of Professor Chas Warkomski, I felt encouraged to pursue a career in orthodontics.


Early into your career, you took over a practice from a retiring doc. As you think back to those days, what comes to mind?
The first five years of my career were filled with challenges. I took over a practice from a seasoned doctor who’d been searching for years for an associate to succeed him. Although he had initiated the transition process with a few potential successors, those efforts never materialized.

Like many new owners, I had to learn how to balance clinical work with team management. It wasn’t easy. One significant hurdle was transitioning the practice to a paperless system. I thought it would be a no-brainer, but it turned out to be a stressful ordeal for the team, leading some to tears.

Building relationships with established dentists and specialists for referrals was another tough nut to crack; despite numerous lunches and study groups, the return was minimal.

I can’t offer a magic formula for success, but what helped me was the influx of younger specialists into the market. Collaborating with them was easier, and the enhanced communication led to smoother case management and happier patients. So my advice is to find a like-minded group of specialists to collaborate with; it can make a significant difference.

As for managing existing staff, here’s a potentially unpopular suggestion: Consider letting the entire team go and rehiring them under your new corporation. This allows you to reset bonuses, pay scales and accrued benefits, giving you the chance to choose which ones to honor. Speak with the outgoing doctor to identify key players you might want to keep. This strategy provides an opportunity to part ways with team members who may not fit your vision, without the complications of unemployment claims. I learned this the hard way when a financial manager left suddenly, right after the transition, and filed a workers’ compensation claim that haunted me for years.

Consultants often suggest maintaining the status quo to keep things stable. This may work for some, but it’s essential to prepare the team for inevitable changes under new leadership. Remember, most practices see a complete staff turnover within five years of a transition, so change is unavoidable. You can either make it a slow, drawnout process or tackle it head-on to minimize prolonged difficulties.




Give us the rundown on how you went from a single office to more than half a dozen.
The catalyst for opening an office in addition to our original one came when my brother-in-law expressed a desire to own and manage a dental practice. He had been a practicing pharmacist on the East Coast but was eager for the entrepreneurial opportunity. He relocated his family to the West Coast, where he began learning the intricacies of running a dental office. Simultaneously, my wife and I embarked on the search for a location for our third office.

Consultants often liken the expansion from two to three offices to the challenges of having a third child— it can be the most demanding phase. Fortunately, we had a trusted partner to help manage the third office and make the leap less demanding.

With each new office added, new challenges emerged, necessitating a centralized support system. One of the first support roles we created was a dedicated insurance verification specialist. We hired a team member specifically for this position, providing support to the front office teams at all of our practice locations. Over time, we also introduced a billing specialist to assist our offices. As the demand for auxiliary support for our on-site teams increased, the need for specialized support teams for various tasks across all offices became evident.

Having these support systems in place made opening new offices more manageable; we didn’t need to reinvent the wheel each time. Our support team has since expanded to include roughly 80 team members, consisting of a contact center, a virtual treatment coordinator, a front office support team, a credentialing specialist, a virtual project coordinator, a purchasing manager and executive assistants, all contributing to our organizational efficiency.


Tell us about your wife’s role in the practices and how having an in-house pediatric dentist shapes the way business gets done.
As many readers may assume, having a pediatric dentist as part of our practice (and the resulting in-house referrals) is a true luxury and a blessing. However, it’s not just about the referrals; my approach to treatment and practice has also significantly evolved thanks to the feedback I’ve received from my wife.

For instance, when my wife refers a patient to me for an orthodontic exam and they decide not to proceed with treatment, she follows up during their dental recall appointment. During these follow-ups, she inquires about their experience with the orthodontic process and any feedback from the parents is relayed to me. This feedback loop has provided insight into the parents’ mindset and the obstacles that may have prevented their children from starting orthodontic treatment. Without it, we would be left in the dark, not fully comprehending why some patients didn’t move forward after their exams.

I believe this feedback loop has been a cornerstone of our success, differentiating our practices from others and ensuring we’re finely attuned to our patients’ needs and expectations in a truly unique way. Essentially, we have two specialists who can divide tasks, and our distinct strengths and weaknesses complement each other’s.


What were some of the initial challenges of merging pediatric dentistry and orthodontics?
In the early stages, I attempted to simply “tack on” a pediatric office. However, that approach was overly simplistic. One significant challenge arose from the fact that in a pediatric office, the sound of children crying is a common occurrence, which wasn’t something my orthodontic patients were accustomed to. At that time, our office lacked dedicated private rooms and followed the open design typical in many orthodontic offices. Our orthodontic patients were uncomfortable with this new environment.

Additionally, the transition posed a new learning curve for our existing orthodontic assistants. Even routine tasks, such as placing bands for space maintainers, became unfamiliar and challenging when dealing with patients who had smaller mouths and shorter attention spans. Basic commands like, “Open wide!” no longer sufficed without playful sound effects and charming gestures. By contrast, the energy and enthusiasm demonstrated by the pediatric assistants were on par with what you might expect from hosts on children’s TV shows, accentuating the stark difference between the two specialties.

It became evident that to successfully integrate an orthodontic/pediatric dentistry practice, we needed an overhaul of our office design, assistant training and overall office culture.

Now, all team members are crosstrained in orthodontics and pediatrics. We typically hire new team members for the pediatric side first; once they exhibit mastery in pediatric care, we select those with the potential to become skilled orthodontic assistants.


What does your day look like, from the standpoint of a practicing doc?
I still work clinically and see patients as needed, but my day-to-day responsibilities vary significantly based on current demands and priorities.

For instance, if we’re in the process of constructing a new office, a substantial portion of my time is dedicated to working closely with architects and contractors and overseeing progress on the job site. Over the past two years, we have established three new practice locations, including our central headquarters facility. During this period, my role often resembled that of a contractor more than that of a practicing orthodontist.

I also take on the responsibility of overseeing our IT needs, which encompasses a wide array of tasks, ranging from addressing simple computer troubleshooting issues to strategizing the development and expansion of our IT infrastructure. The ultimate goal is to ensure our network can effectively handle the increased demands placed upon it as our organization continues to grow.

When it comes to managing the orthodontic team and doctors, my primary focus is on maintaining a high standard of patient care. As we experience growth and welcome new team members, we naturally encounter greater variability in terms of skill levels and the speed at which individuals acquire new skills. My role is to navigate this landscape and ensure our patient care consistently excels while optimizing efficiency. We achieve this with the aid of technology such as Trainual, where team members engage in an orthodontic training program I developed.

Each day brings its own set of unique challenges, which keeps my role fascinating and far from routine. I’m not just an orthodontist; I find myself wearing multiple hats, constantly adapting to new situations. Whether it’s solving complex problems or pioneering new office strategies, these tasks sharpen my adaptability and problem-solving skills.


How do you handle the practice management side?
Managing numerous offices and a team of more than 150 people necessitates the use of cutting-edge technology. The introduction of Slack to our interoffice communication has significantly transformed the way we collaborate internally. Real-time messaging allows for the immediate relay of messages between team members, which is vital during times of last-minute schedule changes and emergencies, and for sending reminders across different office locations. Seamless file sharing has also significantly reduced our reliance on email. Moreover, collaboration has become more streamlined with the creation of dedicated channels for specific projects or departments.

Additionally, we have implemented artificial intelligence technology in our patient contact center. Previously, our response to patient complaints received over phone calls was more reactionary: Identifying such a call involved a time-consuming manual search through a vast database of recorded calls, followed by extensive listening to isolate the relevant ones.

Now, with AI integration, our contact center has transitioned to a more proactive and efficient approach. The AI system can detect calls with specific patient sentiment, automatically alerting our managers. It also identifies key phrases within the call, transcribes that portion and promptly emails it to the managers. This has significantly improved our response time in addressing patient concerns and has elevated our overall patient experience.

Access to precise, real-time data is also imperative for effective management across multiple locations. This data provides valuable insights that enable each department to refine their operations. For example, our marketing team relies on detailed patient demographics for targeted campaigns, while our operations team uses appointment and patient flow data to ensure smooth clinic operations. Crucially, our finance team uses this data for accurate revenue analysis, facilitating informed financial decisions and strategic planning.

In terms of patient satisfaction, the integration of advanced technologies has been paramount. There’s a prevailing notion that larger practices can’t provide the same level of patient care as smaller, solo offices, but I firmly believe that with the technologies we’ve implemented, we’re not just meeting but exceeding the patient satisfaction levels of many stand-alone practices.


What are some specific tips you have for docs looking to expand?
To overcome the initial hurdle and pave the way for growth and expansion, stepping out of the clinic chair is crucial. Hiring a part-time associate is the perfect step toward achieving this goal. If you’re tied to the clinic chair full time, there simply aren’t enough hours in the day to concentrate on growth. In our case, exponential growth truly started when my wife and I transitioned out of the clinic chair.

I recognize taking this first step can be daunting because it often comes with a fair share of anxiety. Many doctors fear that the quality of treatment may decline and their existing patient base may react unfavorably. It’s a natural instinct, especially for practice owners, to cling to control. This challenge only intensifies the longer you have been in the field. However, it’s essential to realize that letting go is a necessary step and you, as the owner, may be the bottleneck to your practice’s potential growth.

Ensuring a successful transition hinges on hiring the right associate— one who aligns with both your treatment philosophy and core values. (One might share your core values but then treatment-plan significantly more aggressively, or vice versa.)

Additionally, there are organizations designed for dental entrepreneurs, consisting of dentists united by their vision for expansion. Engaging with these groups and networking with peers who have navigated similar hurdles can be incredibly advantageous.

Initially, we could not have envisioned managing the number of offices and team members we do today. But as we resolved one issue after another, our team naturally grew. With most of the support systems now established, opening new offices has become far less intimidating. The process is one of continuous improvement and perpetual growth.


Top products
SprintRay
SPRINTRAY EQUIPMENT
We have many pieces of equipment from this company, including the Pro 95S Printer, Pro Wash/Dry and Pro Cure 2. Incorporating 3D printing has been one of the most significant changes to our practice in the past five years. The introduction of scanning and printing technology has effectively addressed many of the inconsistencies associated with alginate impression taking, which often resulted from variations in the skill levels of our back-office team members.

DIBS AI BY ORTHOSELECT
This has been a substantial improvement in our overall practice flow. This innovation empowers our assistants to manage a significant portion of the bonding process, allowing our doctors more time to focus on patient care and effectively oversee the clinic’s operations.

GC ORTHODONTICS BRACKETS
Specifically, Rhodium brackets and wires, heat-treated stainless steel archwires, Legend Mini MBT brackets, 0.018-inch slot. The quality of Japanese-manufactured brackets, given their price, is truly unmatched. With these brackets now available through GC Orthodontics without the heavy mark-ups, the pricing has become exceptionally economical. I particularly favor their Rhodium brackets because of their ability to offer an aesthetic appearance without the bulkiness and susceptibility to fractures often associated with ceramic brackets.

ANGEL ALIGNERS
With the emergence of numerous aligner companies in the orthodontic market, I had been actively seeking a viable alternative to the brand we had been using. While there are various options available, the existing combinations of quality, user-friendliness, and cost had not persuaded me to make the transition. However, this perspective changed when I was introduced to Angel Aligners. The quality, innovation, and proven track record overseas provided me with the confidence that their aligners could deliver the same results as Invisalign but at a fraction of the cost.

TRAINUAL
As my practice expanded to encompass multiple locations, the task of training the entire orthodontic team became increasingly difficult. To address a multitude of challenges, I now use Trainual, an online training software, to accomplish many tasks. I’ve developed a comprehensive training program, which involves creating chapters, recording instructional videos in which I explain various subjects, and designing tests to ensure that team members have grasped the core material. This effort has taken me more than a year to put together, essentially constituting a full course on orthodontics. However, it has enabled me to consistently maintain a high standard of training, even in the face of a constantly changing roster of assistants in our practices.
Tell us how you train all the members of your team.
To ensure the quality of our patient care did not decline as we expanded, I’ve devoted a considerable amount of time to training.

Training became more complex with our growth. Thirteen years ago, when it was solely my practice, organizing a training session for my five back-office team members was a simple affair: We would take advantage of any opening in the schedule to gather for an impromptu training session. I was intimately familiar with each assistant’s clinical abilities and knew precisely what support they required. Now, coordinating training across a large team scattered among various offices presents a monumental challenge, especially when trying to find a time when everyone is available. Moreover, the steady addition of new team members has made it nearly impossible to keep mental tabs on each clinical assistant’s skill level.

Initially, my response to this challenge was to create an organizational hierarchy in which seasoned assistants would mentor new ones. However, I soon noticed discrepancies in the quality of training between trainers and significant skill gaps among assistants with equal experience. This discrepancy showed that clinical skill does not always correlate with teaching ability. Moreover, I discovered unapproved techniques being introduced into our clinical routines, with each assistant adopting their own approach.

The solution came in the form of an online training application called Trainual. Within this application, I developed an orthodontic assistant’s “textbook,” complete with chapters, videos of myself demonstrating procedures and quizzes to ensure comprehension of each chapter’s core concepts. This project has been in development for more than a year and is still evolving. The videos, captured with my phone on a simple tripod and uploaded without elaborate editing, were designed to expedite the delivery of training materials.

With Trainual, managers receive notifications when an assistant completes a quiz, along with their scores. Quizzes are to be taken in the office and, if failed, can only be retaken the following day. After passing, the assistant must demonstrate their competency on a typodont before being authorized to perform the procedure in the clinic. Trainual enables me to personally oversee the training of each new team member, despite my physical absence. The introduction of Trainual has proven to be an invaluable asset.


What’s your opinion on the state of relationships and referrals between orthodontists and the general dentist community? What stands out to you?
The relationship between orthodontists and general dentists is intricate and requires thoughtful handling. There’s a growing inclination among new dental school graduates to directly hire specialists rather than refer patients out—a trend that’s particularly noticeable in a competitive region like Southern California, which has a surplus of specialists. Additionally, thanks to technological advances and comprehensive training programs, general dentists are increasingly able to perform basic orthodontic procedures in-house.

Nevertheless, I’m convinced that the connection between orthodontists and general dentists remains essential. Complex cases beyond the general dentist’s expertise will always emerge, and when orthodontists step in to assist, it builds a dependable, trustfilled partnership.

Furthermore, considering the economics of dental practice, orthodontic treatments—with their lengthy timelines—may not present the most financially sensible option for a busy general dentist, who may find shorter, more lucrative procedures preferable. And the high demand for skilled assistants and the potential instability in specialist staff can lead practices to reconsider the practicality of in-house orthodontic services.

It’s for these reasons that maintaining a positive rapport with local general dentists is crucial—not only for immediate referrals but also as a long-term strategy for professional cooperation and collective patient care quality.


Your practices cover a dense area. How do you handle patient flow?
Managing patient flow across our practices, which cover a large and bustling area, has been a challenge we’ve strategically addressed to meet the needs of today’s busy urban parents.

Our offices are located within 30 minutes of each other, offering patients the flexibility to choose the location that best fits their dynamic schedules. Even though patients may live in one area, their children’s school or extracurricular activities might be closer to another office. Instead of sitting in Southern California traffic to rush back to the original practice location, parents can choose any practice that is more convenient for them—a convenience significantly appreciated by our patients.

Initially, this level of convenience wasn’t possible. We had servers at each location that were isolated and not part of a network. As a result, if a patient visited different offices, the treatment notes would be fragmented, leading to confusion and inefficiency.

To achieve a seamless experience and eliminate the risk of fragmented chart notes across multiple offices, we invested significantly in our IT infrastructure several years ago. Now, all our offices are interconnected via a VPN to a central server that hosts a unified patient database. This ensures that a patient’s chart notes are consistent and complete regardless of which office they visit. By centralizing our records, we’re able to offer a smooth, continuous treatment experience. No matter where our patients choose to see us, we’re equipped to provide the consistent high level of care they’ve come to expect.

In addition, our orthodontic appliances are fabricated in our dedicated laboratory at headquarters. Intraoral scans from each office are uploaded to the cloud and 3D-printed at headquarters. Once the appliances are complete, they’re delivered to the office where the patient is scheduled.

Through the use of applications that are not limited by geographical area, and by centralizing many of our functions and services, we’ve been able to offer a level of customer service to our patients that is truly unique and highly valued.


You have an affinity for hiring new grads. What has your experience been with the newer generation of docs?
When it comes to hiring orthodontic associates, I typically prefer recent graduates to those with years of experience. They often retain a student mindset, brimming with eagerness and enthusiasm for learning. This perspective renders them highly receptive to constructive criticism and adaptable to the crucial feedback loops in their professional development. Additionally, they haven’t yet formed treatment habits that could conflict with our practice’s established approach to patient care.

However, their relative inexperience usually calls for a substantial investment of time in training and mentorship. They require instruction not just in clinical skills but also in effective communication with parents and children. Furthermore, they need to develop leadership abilities, such as managing a team and directing patient flow in the clinic—skills that traditional educational settings may not impart.

Transitioning from more than a decade of structured learning to suddenly assuming a leadership role can present a steep learning curve for some, particularly when understanding the responsibilities of a boardcertified orthodontist and managing the expectations of patients, referring dentists, and other specialists.

While I appreciate that many of my colleagues choose seasoned professionals to minimize the training phase, I have found that nurturing the capabilities of new graduates is incredibly fulfilling. Their eagerness to learn and grow transforms them from fresh faces in the clinic to integral members of our practice family, shaping the future of our patient care.


Tell us about the specific office we visited for this photo session.
Building a new office presents its challenges, but it’s an adventure I thoroughly enjoy. Each office gives me the opportunity to play with new design elements—particularly in the reception area, where that first impression can truly wow our patients. By adopting the latest design trends, our offices remain fresh and modern, but I’m careful to ensure each office retains our signature brand aesthetic, providing a sense of familiarity and consistency for our patients at all locations.

Because the orthodontic side also serves adult patients, it’s important for me to create a space that is both childfriendly and sophisticated enough for an adult to feel comfortable receiving treatment. The photos showcase our flagship office, where the high ceilings create a sense of openness and space—a rarity in Southern California, where space is at a premium. This spaciousness also fosters a sense of freedom and reduced confinement, which can be especially comforting in a dental setting where patients might otherwise feel anxious. The dramatic pendant and sculpted ceiling elements not only make a visual impact but are constructed from acoustic foam, serving a dual function to dampen the typical sounds of a dental office.

The treatment coordinator’s room is at the heart of the back office. Positioned prominently and encased in glass, it serves as a functional space and a design statement that neatly demarcates the orthodontic and pediatric treatment areas. The bursts of color on the floor add a touch of whimsy and break up the uniform color scheme. My goal is to build offices that are places of professional expertise infused with comfort, ensuring that everyone who walks in feels immediately at ease.


What advice do you have for doctors fresh out of school or just starting out in practice?
Exercise great care in selecting your first workplace. The setting in which you practice during your initial three to five years can significantly shape the kind of doctor you’ll become for the rest of your career. Through working with numerous associate doctors over the years, I’ve noticed that once certain habits are ingrained, they become challenging to change.

In a neutral interview setting, associate doctors often agree wholeheartedly with the owner-doctor’s treatment philosophy and office culture—and I believe their responses are genuine. Checking in a few months later can reveal a very different treatment pattern, however. While this pattern doesn’t hold true for every associate doctor, it’s something we’ve experienced quite frequently.

I recognize that every new graduate has unique priorities, and I’m not here to pass judgment. For instance, if you’re graduating from school with substantial debt and have a young family to support, joining a highproducing corporate practice might be your best option. However, always keep in mind the kind of dentist you aspire to be throughout your career.

Make a conscious effort to choose a workplace that aligns with your professional goals and values. Despite the pressures of debt, try to strike a balance and find a position in a private office where mentorship is available. It’s all too easy to fall into a routine; before you know it, you could find that you’ve been practicing in one particular style for years.


How do you think the landscape in orthodontics will look in 10 years?
Since the day I graduated from orthodontic residency, there has been discussion about the changing dynamics of dentist-specialist referrals. The traditional referral stream is being reshaped as more general dentists choose to broaden their range of services, aspiring to be “super GPs” capable of managing a wider array of treatments, including orthodontic care. This shift is expected to be propelled by advances in dental education and technology, which enable general practitioners to carry out procedures traditionally reserved for specialists.

Orthodontists, in response, may find themselves focusing on more specialized niches or complex cases that demand their distinct expertise. On another front, we might see a continuation of the trend toward consolidation, with orthodontists becoming integral to larger, multispecialty groups that offer comprehensive care in a single setting, which can improve collaboration and patient convenience.


What kind of cases excite you the most?
Two types of cases really pique my interest and enthusiasm. First are the Phase I patients. I understand the need for Phase I treatment is a topic of debate among orthodontic professionals, and that excellent outcomes can still be achieved without it. However, I firmly believe that by treating patients at an earlier age, we’re placing them on the best trajectory for their future dental health.

Issues we frequently address in later orthodontic stages often have their roots in early childhood. For instance, the early loss of a primary tooth may lead to subsequent alignment challenges and midline shifts. By intervening at the onset of these issues, we can often avoid more invasive procedures. To me, that represents the pinnacle of patient care.

The second category that captures my interest is the highly complex cases—ones that pose intricate challenges that demand the full extent of my professional expertise and creativity. Addressing these cases is about more than just technical skill; it requires innovative problem-solving and, occasionally, collaboration with fellow dental specialists such as oral surgeons or periodontists.


Give us a snapshot of your life outside of orthodontics.
Overseeing our extensive practice network means we’re always on call. Even when we’re not physically present at the office, a series of decisions, remote meetings and phone calls all demand our attention. Many colleagues discuss striving for work-life balance to manage the stresses of practice ownership. However, I recall Jeff Bezos once stating that the concept of “worklife balance” is misleading because it implies a rigid separation between the two. Bezos proposed that it’s less about a strict division and more about discovering joy in the everyday hustle, aiming for harmony instead of balance. I agree with his philosophy.

But to truly step away from work and recharge, travel has been key for our family. It’s our way to press pause on the professional demands and immerse ourselves in quality time with each other. These getaways are more than mere breaks; they’re chances to create memories that rejuvenate and motivate us, and we bring back that renewed energy and perspective to our practices. It’s about blending personal fulfillment with professional dedication in a way that energizes both sides of our lives.

Orthotown Magazine
October 2025
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