Its headquarters are in the Kool Smiles Patient Support Center in Marietta, Georgia, U.S., in Greater Atlanta and has over 100 offices located across sixteen states.

In August 2002, the first Kool Smiles location opened in East Lake, Atlanta, in DeKalb County,[6] near the city of Decatur.

[11] After the WellCare and Peach State Medicaid networks followed through with plans to terminate Kool Smiles from their contracts, patients of Kool Smiles and another company filed an injunction that would prevent the terminations until WellCare and the Peach State organizations would show that the ending of the contracts would not contradict Medicaid dental program requirements.

[14] The company has also partnered with the Governor of Maryland, Martin O'Malley, on his "Healthy Smiles Tour" to improve access to dental care in the state.

"[18] Kool Smiles pointed to a study authored by presidential economist Arthur Laffer, which reviewed Texas Medicaid claims data and concluded that, in 2011, Kool Smiles charged less and performed fewer procedures, including crowns, per patient than other Medicaid dental providers in the state.

"[20] Later it was revealed Frontline had used a former employee as a source who was a convicted felon, who was suing the company after being terminated for allegedly falsifying documents.

As one of the leading providers of DSOs in the United States, Kool Smiles' statistics were regularly quoted during this period.

The federal government alleged that the company filed false claims for unneeded dental procedures performed on children, including tooth removals, pulpotomies, and installing stainless steel crowns.

[23] Zion Gastelum, 2, died four days after a December 2017 visit to a Kool Smiles dental clinic in Yuma, Arizona, where he became unresponsive after being placed under anesthesia by Dr. Aaron Roberts.

The plaintiffs alleged that the procedure, which included six root canals and crowns as well as a "cosmetic" enameloplasty, was unnecessary and performed "without truly informed consent from the parents".

[24] In addition, the suit claimed that "a Kool Smiles staff member silenced the alarm on the pulse oximeter, which is used to monitor a patient's pulse and oxygen saturation", and that "Zion was left alone in the recovery room and an oxygen tank Zion was hooked up to was either empty or not working properly.

[29] The company headquarters are located in the Kool Smiles Patient Support Center in Suite 290 of the Northchase Office Park building in Marietta, Georgia, U.S., in Greater Atlanta.