Los Altos · Mountain View · Gen4 Dental Brand
The agency has built a thorough framework but is operating it with structural settings that throttle a $26,000/month cosmetic dental program. The strongest work is the negative keyword infrastructure (six shared lists, 3,300+ negatives). The most damaging issues are conversion tracking that visibly captures only phone calls from the call extension, brand campaigns that are paused on both accounts (leaving doctor-name queries exposed to competitor conquest), a -100% desktop bid modifier applied across most cosmetic-relevant campaigns, and financing absent from 99.5% of ad copy in a Bay Area cosmetic market where financing is the conversion lever for $15K-30K cases.
The account also has no Customer Match audiences, no dental implant or full-arch campaigns despite the practice being named "Peninsula Center of Cosmetic Dentistry," and three abandoned Performance Max attempts on the Los Altos account alone. This audit lists nine Critical issues, eight Needs-Work issues, and three Strengths. Highest-leverage fixes are listed in the prioritized action plan below.
Structural snapshot of both accounts as of 2026-05-14. Performance numbers (CPA, ROAS, conversion volume, search-term waste) require the YTD web-UI exports and are flagged in the "What's Missing" section.
Standard paid-media audit framework applied to a cosmetic dental account. Scores reflect structural inspection only; conversion-driven pillars (search term waste, change history, performance) await the YTD UI exports.
| # | Pillar | Score | Headline Finding |
|---|---|---|---|
| 1 | Account Structure & Taxonomy | Needs Work | Service-line separation exists but funnel is BOFU-only; cosmetic services collapse to one campaign per account. |
| 2 | Conversion Tracking Integrity | Critical | Only Call Asset Phone Call is visible. No form, no booking, no scored-call tracking surfaced in the Editor export. |
| 3 | Bid Strategy Fit | Needs Work | All campaigns on Max Conversions with target $0. Account is 10 months old; tCPA with real targets is overdue. |
| 4 | Keyword Strategy & Match Type | Strong | 2,515 positive keywords across phrase + exact. Cosmetic long-tail (veneers + city + CA) is solid. |
| 5 | Negative Keyword Hygiene | Strong | Six shared negative lists totaling 3,300+ unique negatives applied across 11 campaigns. WNDR did this well. |
| 6 | Search Terms Quality (n-gram) | N/A — data needed | Requires YTD search-terms report from the web UI. |
| 7 | Audience Layering | Critical | Two interest-based audiences, no Customer Match, no remarketing, no lookalikes despite multi-year patient data. |
| 8 | Ad Copy & Assets | Critical | Financing absent. Generic templated copy. 81% of ad groups have one RSA. Policy-risk superlatives across callouts. |
| 9 | Extension / Asset Coverage | Needs Work | Sitelinks and callouts well-covered. Call extensions on every LAL campaign; MV coverage thinner. No location asset linked to GBP. |
| 10 | Geo, Schedule, Device | Critical | Desktop -100% on most cosmetic-relevant campaigns. Location targeting mixes Presence and Presence-or-Interest. |
| 11 | Change History & Management Cadence | N/A — data needed | Requires YTD change history export from the web UI. |
11 enabled campaigns across two accounts at a combined daily budget of $864.12 (~$26,269/month). 17 additional campaigns sit paused or ended.
| Campaign | Type | Status | Daily Budget | Bid Strategy | Desktop Mod |
|---|---|---|---|---|---|
| Search - Cosmetic | Search | Enabled | $162.54 | Max Conv | -100% |
| Search - General | Search | Enabled | $142.44 | Max Conv | -10% |
| Search - Sedation | Search | Enabled | $84.77 | Max Conv | 0 |
| Search - Crowns | Search | Enabled | $72.21 | Max Conv | 0 |
| Search - Emergency | Search | Enabled | $71.63 | Max Conv | 0 |
| PMax - General | PMax | Enabled | $24.28 | Max Conv | 0 |
| Search | Brand | Search | PAUSED | $13.50 | Max Conv | 0 |
| Dentist - Near Me | Search | PAUSED | $85.00 | Max Conv | -100% |
| Dentist | After Hours | Search | PAUSED | $30.00 | Max Conv | -100% |
| Search | Cosmetic - LP #2 | Search | PAUSED | $58.70 | Max Conv | -100% |
| Bonding, Smile Makeover, Invisalign, PMax 1, PMax New | Various | PAUSED | $103.00 | Mixed | Mixed |
| Campaign | Type | Status | Daily Budget | Bid Strategy | Desktop Mod |
|---|---|---|---|---|---|
| Search - General | Search | Enabled | $70.98 | Max Conv | -100% |
| Search - Cosmetic | Search | Enabled | $64.69 | Max Conv | -100% |
| Search - Emergency | Search | Enabled | $62.60 | Max Conv | -100% |
| Search - Sedation | Search | Enabled | $50.00 | Max Conv | -100% |
| Search - After Hours General | Search | Enabled | $32.85 | Max Conv | -100% |
| PMax - General | PMax | Enabled | $25.13 | Max Conv | 0 |
| Search | Brand | Search | PAUSED | $10.00 | Max Conv | 0 |
| Bonding, Smile Makeover, Near Me, PMax 1 | Various | PAUSED | $321.65 | Mixed | Mixed |
Nine issues rated Critical. Each is observable in the Editor export and each materially throttles the program in its current state.
The only conversion action referenced across the entire export is "Call Asset Phone Call" (12 references). No form-submission conversion, no website call tracking, no booked-appointment offline import is visible. This account spends $26,000/month on a service where the typical cosmetic consultation is generated via a form on a NewPatientSpecial landing page or a website call (not just a call extension tap). If forms are being tracked at the account-level "Standard conversion goals" layer, that field is empty on every campaign in this export.
Both accounts have well-built brand campaigns covering the practice name plus six doctor names (Marlana Shile, Joseph Field, Karl Supal at LAL; Theresa Ta, Scott Oh, Ratna Indah, plus "mountain view dental arts" at MV). Combined daily budget if enabled would be $23.50. They are paused. Every time a patient searches for the practice by name or for one of the doctors, a competitor can win the click and the practice pays nothing to protect its own brand. In the Bay Area dental market this is unforced spend leakage.
Desktop modifier is -100% on Search Cosmetic LAL ($162.54/day), Search Cosmetic-LP #2 LAL, Bonding LAL, Smile Makeover LAL, all five enabled MV campaigns, plus several paused campaigns. -100% means desktop traffic gets zero impressions on these campaigns. For cosmetic dentistry, desktop is 30-40% of the addressable audience (these are researchers comparing veneer dentists on bigger screens). The agency has effectively eliminated a third of the cosmetic market.
Out of 3,232 unique headlines and 857 descriptions across 221 ads, financing language appears in 15 headlines (0.5%) and 0 descriptions (0.0%). No "$X/month" copy. No Care Credit / Sunbit / Cherry / LendingClub mentions in ad copy. For a Bay Area cosmetic practice where a veneer case runs $15K-30K and full-arch reaches $40K+, financing is the second-most-clicked decision behind the offer itself. The callout extensions do include "Flexible Financing" once, but it doesn't show up in headlines or descriptions where it would drive click-through.
Zero Customer Match lists are uploaded. The two audience attachments on the account are interest-based ("Cosmetics - Professionals" targeting "Banking & Finance > Avid Investors"; "General Dentist - Parents" with no segments populated). Each practice has been operating for years and has a patient list, a cosmetic-treatment history, and unbooked-consult records sitting in their PMS. None of that is feeding Google Ads as audience signal, exclusion, or Offline Conversion Import.
The practice is named "Peninsula Center of Cosmetic Dentistry" and the structured snippet lists "Implants & Dentures" as a service. Yet there are zero dental implant keywords across either account, no full-arch campaign, no All-on-4 ad group, no veneers + implants combo strategy. Implant searches in Los Altos and Mountain View are some of the highest-value commercial queries in dental ($25-60 CPC, $3,500-50,000 case value). The practice is leaving the most lucrative service line entirely uncovered on paid search.
cosmetic-dental-paid-media-audit/references/cosmetic-playbook.md. Single-tooth implant CPB targets $400-1,200 in Tier 1; full-arch $1,500-5,000.Targeting method is "Location of presence or Area of interest" on Bonding LAL, Smile Makeover LAL, Dentist Near Me LAL, Brand LAL, After Hours LAL, Crowns LAL, Cosmetic-LP #2 LAL, both Test LP campaigns, the older PMax LAL, plus Bonding MV, Near Me MV, and Smile Makeover MV. "Presence or Interest" leaks budget to searchers who are merely researching about the area but don't live there. For a local dental practice, this is unforced waste.
The same description copy ("Experience A Dental Transformation That Prioritizes Your Comfort And Confidence. Call Now.") appears across many cosmetic ad groups. The Bonding ad group sends searchers to the same smile-makeover landing page as the Veneers ad group. Headlines lean on "Smile Test Drive" as the primary offer (good idea, generic execution). 81% of ad groups have a single RSA, leaving no A/B test surface. The cosmetic copy is not differentiated by service line, doctor, or case value bracket.
Los Altos has three Performance Max campaigns: an old one with 10 themed asset groups (paused), a "PMAX New" one with a single generic asset group (paused), and an enabled "PMax General" with three asset groups whose search themes include the literal text "GEO" instead of "Los Altos" (e.g., "dentist in GEO", "best dentist in GEO"). The enabled PMax asset groups also have zero videos and only three headlines per group. This is the classic PMax Dump Truck anti-pattern: keep trying, never tune, never commit. Mountain View shows the same pattern with two PMax campaigns.
Issues that don't rise to Critical but limit performance ceiling or expose policy risk.
All 11 enabled campaigns run Max Conversions with target_cpa = $0. The account has been live since July 2024 (10+ months). For Search campaigns at $2K-5K monthly spend with sufficient conversion volume, Target CPA is the standard next step. Max Conversions on a fixed daily budget produces erratic spend and no CPA discipline.
77 of 213 PMax search themes include "best", "top", "most highly rated", or contain the literal text "GEO" as a placeholder. Themes drive impression matching; ad copy must legally substantiate claims it can deliver. The agency is asking Google to serve ads on "best cosmetic dentist near me" while the ad creative cannot claim to be the best.
Callouts include "Award-Winning Team", "Nationally-Recognized", "World-Class Dentists", "Renowned Cosmetic Dentist", "Renowned Dentists", "Renowned Dental Office", "Renowned Office". Headlines include similar superlatives at 4.2% frequency (136 of 3,232). One ad is currently in "Approved Limited" status (the "Local Sedation Dentistry" RSA in PCCD-MV General). The disapproval window for Bay Area healthcare is tightening; these phrasings will catch up with the account.
149 of 184 ad groups have one RSA only. Two RSAs minimum per ad group is current best practice so the algorithm has a serve-rate test surface. With one RSA, no learning is possible.
Only two audience attachments visible (Cosmetics - Professionals; General Dentist - Parents). Both are interest-based. Search campaigns benefit from Observation audiences (in-market dental services, custom intent from research queries). Demand Gen and PMax benefit from Customer Match seeds and lookalikes. None of these are in place.
52 ads on PCCD-LAL point to the same /nps page; 25 ads point to /smilemakeover-losaltos2 including the Bonding, Veneers, Cosmetic Dentist, and Smile Makeover ad groups. A Bonding searcher (typically a one-tooth, lower-ticket prospect at $300-1,000) is landing on a Smile Makeover full-treatment page, which mismatches the offer and depresses conversion rate. The Sedation campaign also routes to pccdsmiles.com (the real practice site) while everything else routes to newpatientspecial.com, inconsistent tracking and design.
All 77 image assets sit at the account level (45 LAL + 32 MV). The enabled "PMax - General" asset groups on both accounts contain zero videos. The paused older PMax campaigns had three videos per asset group, suggesting WNDR has assets but didn't migrate them. For cosmetic, video is the highest-converting Demand Gen / PMax creative.
Dental LSA is increasingly available in California metros. The account does not show any LSA activity in this export. Location asset (linking to Google Business Profile for the location extension) is not visible in the Editor export's asset section. LSA charges per qualified lead and sits above paid Search, providing diversification.
The agency has done some things well. Audit reports that don't acknowledge what's working undermine their own credibility.
Six shared negative lists applied across 11 campaigns: Universal Negatives (188 KW), International City/Country Negatives (275 KW), Medicaid/Medicare Negatives (210 KW), PCCD-LAL Negatives & Competitor (2,546 KW), All States Except CA (96 KW), PMAX Negatives (16 KW). Plus 140 PMax placement exclusions. This is the most labor-intensive part of dental Google Ads management and WNDR has done it. Most "templated dental agency" accounts have a fraction of this.
Distinct campaigns for Cosmetic, Crowns, Sedation, Emergency, Invisalign, After Hours, Near Me, General, plus Bonding and Smile Makeover (paused). Better service-line segmentation than the typical dental agency. The structural skeleton is sound; the failures are in settings, copy, and tracking, not in architecture.
The Cosmetic campaign on LAL has 244 positive keywords with strong long-tail coverage: "best veneer dentist in Los Altos", "complimentary consultation veneers Los Altos", "best dentist for veneers Los Altos CA", phrase + exact combinations on geographically-anchored queries. The keyword list is one of the better-built parts of the account.
Sorted by impact-to-effort ratio. Items 1-5 are this-week fixes; items 6-12 are 30-day; items 13+ are 60-90 day projects.
| # | Action | Effort | Impact | Owner |
|---|---|---|---|---|
| 1 | Enable both Brand campaigns. Set to Target Impression Share 95%+. | Low | High | WNDR |
| 2 | Remove -100% desktop bid modifier from all cosmetic-relevant campaigns. | Low | High | WNDR |
| 3 | Set location targeting to "Presence" only on all campaigns currently set to "Presence or Interest." | Low | Med | WNDR |
| 4 | Replace "GEO" placeholder text in active PMax search themes with actual market names. | Low | Med | WNDR |
| 5 | Pull Conversion Summary from web UI. Confirm what form, call, and booking conversions are configured. Verify Enhanced Conversions enabled. | Low | High | SGA + WNDR |
| 6 | Add a financing headline and description to every cosmetic ad group. Update callout extensions to include "Care Credit" / "$0 Down Available". | Med | High | WNDR |
| 7 | Add a second RSA per cosmetic ad group, differentiated by angle (financing vs outcome). | Med | Med | WNDR |
| 8 | Replace policy-risk superlatives ("Renowned", "World-Class", "Nationally-Recognized") with verifiable claims ("4.9 on Google", "Featured in [pub]", specific awards). | Med | Med | WNDR |
| 9 | Build separate Bonding and Veneers landing pages. Stop sending Bonding traffic to the Smile Makeover page. | Med | Med | WNDR + NPS |
| 10 | Consolidate PMax to one campaign per account. Pause the abandoned PMax campaigns permanently. Add video assets to active PMax asset groups. | Med | Med | WNDR |
| 11 | Switch eligible Search campaigns from Max Conversions to Target CPA once Conversion Summary verified and targets defined. | Med | Med | WNDR |
| 12 | Resolve the "Approved Limited" ad in PCCD-MV Search General (Local Sedation Dentistry RSA). | Low | Med | WNDR |
| 13 | Upload four Customer Match lists per practice: existing patients (exclusion), past cosmetic patients (lookalike), unbooked consults (re-engagement), email subscribers (warm prospecting). | High | High | SGA + WNDR |
| 14 | Launch dedicated dental implant campaign for both practices. Single-tooth implant CPB target $400-1,200 in Tier 1 Bay Area. | High | High | WNDR |
| 15 | Evaluate full-arch / All-on-4 service availability and launch dedicated campaign if in-scope. | High | Med | SGA + practice |
| 16 | Set up Offline Conversion Import: book-to-treatment data flowing from PMS back to Google Ads as Primary conversion. | High | High | SGA + WNDR + PMS |
| 17 | Evaluate Local Service Ads (LSA) eligibility for both metros and launch if available. | Med | Med | WNDR |
| 18 | Build cosmetic Demand Gen / YouTube top-of-funnel campaign once Customer Match lists are in place. | High | Med | WNDR |
Google Ads Editor exports are structural. The following data sets are required for a full audit and should be pulled from the Google Ads web UI for both account IDs.
| Missing | What it would unlock |
|---|---|
| Search Terms Report (YTD) | N-gram analysis of wasted spend. Quantification of off-intent search-term spend. Validation that negative keyword list catches what's actually showing. |
| Change History (YTD) | Agency management cadence. Frequency of meaningful changes. Confirmation of which anti-patterns apply (Monthly Touch, Cosmetic Change Volume, Auto-Apply Theater, Bid Strategy Roulette). |
| Campaigns-by-Day with conversion data (YTD) | True CPA per campaign. ROAS if revenue tracked. Pacing patterns. Seasonality. Concrete dollar figure on wasted spend. |
| Conversions Summary | Verification of what conversion actions are actually configured at account level. Source, count method, attribution model, click-through window, Enhanced Conversions status. Primary vs Secondary discipline. |
| Auction Insights | Competitor landscape, impression-share-lost-to-rank, position vs key competitors (e.g., Aspen Dental, ClearChoice if implants). |
| Device-segmented performance | Whether the -100% desktop bid modifier was data-driven or arbitrary. (Almost certainly arbitrary, but performance data would confirm.) |
inputs/google-ads/PCCD-LAL/ and inputs/google-ads/PCCD-MV/ respectively